Other coverage requirements

Health plans must allow enrollees to continue coverage without proof of insurability if they divorce the primary enrollee or the primary enrollee dies.

Individual and group

Health plans must offer enrollees who are no longer eligible for their group plan, access to a conversion plan. They cannot require proof of insurability or exclude coverage for pre-existing conditions.

Group

Limits the amount health plans may reduce benefits if the contract allows for a reduction in benefits because the enrollee has other coverage.

Individual and group

Health plans that provide coverage at a LTC facility prior to hospitalization must provide coverage at the same LTC facility following hospitalization.

Individual and group

Requires continuation of coverage for children who are incapable of self sustaining employment because of a developmental disability or physical handicap, who are dependent on the subscriber for support.

Individual and group

Health plans cannot refuse to issue, cancel or nonrenew a policy because of a mastectomy or lumpectomy performed on the enrollee more than five years earlier.

Individual and group