
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC300gg-42]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
   SUBCHAPTER XXV--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
 
                     Part B--Individual Market Rules
 
      subpart 1--portability, access, and renewability requirements
 
Sec. 300gg-42. Guaranteed renewability of individual health 
        insurance coverage
        

(a) In general

    Except as provided in this section, a health insurance issuer that 
provides individual health insurance coverage to an individual shall 
renew or continue in force such coverage at the option of the 
individual.

(b) General exceptions

    A health insurance issuer may nonrenew or discontinue health 
insurance coverage of an individual in the individual market based only 
on one or more of the following:

                     (1) Nonpayment of premiums

        The individual has failed to pay premiums or contributions in 
    accordance with the terms of the health insurance coverage or the 
    issuer has not received timely premium payments.

                              (2) Fraud

        The individual has performed an act or practice that constitutes 
    fraud or made an intentional misrepresentation of material fact 
    under the terms of the coverage.

                       (3) Termination of plan

        The issuer is ceasing to offer coverage in the individual market 
    in accordance with subsection (c) of this section and applicable 
    State law.

                  (4) Movement outside service area

        In the case of a health insurance issuer that offers health 
    insurance coverage in the market through a network plan, the 
    individual no longer resides, lives, or works in the service area 
    (or in an area for which the issuer is authorized to do business) 
    but only if such coverage is terminated under this paragraph 
    uniformly without regard to any health status-related factor of 
    covered individuals.

                  (5) Association membership ceases

        In the case of health insurance coverage that is made available 
    in the individual market only through one or more bona fide 
    associations, the membership of the individual in the association 
    (on the basis of which the coverage is provided) ceases but only if 
    such coverage is terminated under this paragraph uniformly without 
    regard to any health status-related factor of covered individuals.

(c) Requirements for uniform termination of coverage

             (1) Particular type of coverage not offered

        In any case in which an issuer decides to discontinue offering a 
    particular type of health insurance coverage offered in the 
    individual market, coverage of such type may be discontinued by the 
    issuer only if--
            (A) the issuer provides notice to each covered individual 
        provided coverage of this type in such market of such 
        discontinuation at least 90 days prior to the date of the 
        discontinuation of such coverage;
            (B) the issuer offers to each individual in the individual 
        market provided coverage of this type, the option to purchase 
        any other individual health insurance coverage currently being 
        offered by the issuer for individuals in such market; and
            (C) in exercising the option to discontinue coverage of this 
        type and in offering the option of coverage under subparagraph 
        (B), the issuer acts uniformly without regard to any health 
        status-related factor of enrolled individuals or individuals who 
        may become eligible for such coverage.

                 (2) Discontinuance of all coverage

        (A) In general

            Subject to subparagraph (C), in any case in which a health 
        insurance issuer elects to discontinue offering all health 
        insurance coverage in the individual market in a State, health 
        insurance coverage may be discontinued by the issuer only if--
                (i) the issuer provides notice to the applicable State 
            authority and to each individual of such discontinuation at 
            least 180 days prior to the date of the expiration of such 
            coverage, and
                (ii) all health insurance issued or delivered for 
            issuance in the State in such market are discontinued and 
            coverage under such health insurance coverage in such market 
            is not renewed.

        (B) Prohibition on market reentry

            In the case of a discontinuation under subparagraph (A) in 
        the individual market, the issuer may not provide for the 
        issuance of any health insurance coverage in the market and 
        State involved during the 5-year period beginning on the date of 
        the discontinuation of the last health insurance coverage not so 
        renewed.

(d) Exception for uniform modification of coverage

    At the time of coverage renewal, a health insurance issuer may 
modify the health insurance coverage for a policy form offered to 
individuals in the individual market so long as such modification is 
consistent with State law and effective on a uniform basis among all 
individuals with that policy form.

(e) Application to coverage offered only through associations

    In applying this section in the case of health insurance coverage 
that is made available by a health insurance issuer in the individual 
market to individuals only through one or more associations, a reference 
to an ``individual'' is deemed to include a reference to such an 
association (of which the individual is a member).

(July 1, 1944, ch. 373, title XXVII, Sec. 2742, as added Pub. L. 104-
191, title I, Sec. 111(a), Aug. 21, 1996, 110 Stat. 1982.)


                             Effective Date

    Section applicable with respect to health insurance coverage 
offered, sold, issued, renewed, in effect, or operated in the individual 
market after June 30, 1997, regardless of when a period of creditable 
coverage occurs, see section 111(b) of Pub. L. 104-191, set out as a 
note under section 300gg-41 of this title.
