Section 45-06-12-02 - Prohibiting discrimination against participants and beneficiaries based on health status-related factors1. An insurer offering group health insurance coverage in connection with a group health benefit plan may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the plan based on a health status-related factor, as defined in subsection 20 of North Dakota Century Code section 26.1-36.3-01. 2. Subsection 1 shall not be construed to: a. Require an insurer to provide particular benefits other than those provided under the terms of the plan or coverage; or b. Prevent the insurer from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage. 3. An insurer offering group health insurance coverage in connection with a group health benefit plan may not require an individual as a condition of enrollment or continued enrollment under the plan to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan based on any health status-related factor, as defined in subsection 20 of North Dakota Century Code section 26.1-36.3-01. 4. Subsection 3 shall not be construed to: a. Restrict the amount that an employer may be charged by an insurer for coverage under a group health benefit plan; or b. Prevent the insurer from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence for a bona fide wellness program. For purposes of this subsection, a bona fide wellness program is a program of health promotion and disease prevention. N.D. Admin Code 45-06-12-02
Effective December 1, 1997.General Authority: NDCC 28-32-02(1)
Law Implemented: NDCC 26.1-36.4