§ 4048e.
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§ 4048e. Replacement coverage
(a)General. When the group health insurance policy or subscriber contract of a health insurer replaces a policy or contract providing similar benefits of another health insurer, the liability of both health insurers shall be as provided in this section and rules adopted pursuant to this section.
(b)Liability of prior health insurer. A prior health insurer remains liable after termination of its policy or contract only to the extent of its accrued liabilities and extensions of benefits.
(c)Liability of succeeding health insurer.
(1)A succeeding health insurer shall offer a group health insurance policy or subscriber contract to replace a prior health insurer’s policy or contract in accordance with the provisions of this subsection.
(2)A succeeding health insurer shall offer a policy or contract to cover all persons who:
(A)are covered or are a member of a class eligible for coverage under the prior health insurer’s policy or contract on the date of termination of the prior health insurer’s policy or contract; or
(B)are a member of a class eligible for coverage under the succeeding health insurer’s policy or contract on the date of termination of the prior health insurer’s policy or contract.
(3)The succeeding health insurer is not liable under this subsection for benefits required to be paid by the prior health insurer.
(4)When replacing a prior health insurer’s plan that is not subject to section 4048d of this title, the succeeding health insurer shall, in addition to the coverage required to be offered under subdivision
(2)of this subsection, offer a policy or contract that provides a level of benefit equal to the lesser of:
(A)the extension of benefits that would have been required if the prior health insurer’s policy or contract was subject to section 4048d of this title; or
(B)the extension of benefits required for the succeeding health insurer’s policy or contract, except that any such benefits may be reduced by benefits actually payable under the prior health insurer’s plan.
(5)The preexisting condition limitation of a succeeding health insurer’s policy or contract shall provide a level of benefits equal to the lesser of:
(A)the benefits of the succeeding health insurer’s policy or contract determined without application of the preexisting conditions limitation; or
(B)the benefits of the prior health insurer’s policy or contract.
(6)The succeeding health insurer, in applying a deductible or waiting-period provision in its policy or contract, shall give credit for the satisfaction of the same or similar provisions under the prior health insurer’s policy or contract.
(7)At the succeeding health insurer’s request, the prior health insurer shall furnish all information needed to determine the benefits available under the prior health insurer’s policy or contract.
(d)Rules. The Commissioner shall adopt rules necessary to carry out the purposes of this section. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)