SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE FOR EMPLOYERS IN THE GROUP MARKET.
Title[ Title I\Subtitle A\Sec. 102 Contents
<<NOTE: 42 USC 300gg-11.>>
``(a) Issuance of Coverage in the Small Group Market.--
``(1) In general.--Subject to subsections (c) through (f),
each health insurance issuer that offers health insurance
coverage in the small group market in a State--
``(A) must accept every small employer (as defined
in section 2791(e)(4)) in the State that applies for
such coverage; and
``(B) must accept for enrollment under such coverage
every eligible individual (as defined in paragraph (2))
who applies for enrollment during the period in which
the individual first becomes eligible to enroll under
the terms of the group health plan and may not place any
restriction which is inconsistent with section 2702 on
an eligible individual being a participant or
beneficiary.
``(2) Eligible individual defined.--For purposes of this
section, the term `eligible individual' means, with respect to a
health insurance issuer that offers health insurance coverage to
a small employer in connection with a group health plan in the
small group market, such an individual in relation to the
employer as shall be determined--
``(A) in accordance with the terms of such plan,
``(B) as provided by the issuer under rules of the
issuer which are uniformly applicable in a State to
small employers in the small group market, and
``(C) in accordance with all applicable State laws
governing such issuer and such market.
``(b) Assuring Access in the Large Group Market.--
``(1) Reports to hhs.--The Secretary shall request that the
chief executive officer of each State submit to the Secretary,
by not later December 31, 2000, and every 3 years thereafter a
report on--
``(A) the access of large employers to health
insurance coverage in the State, and
``(B) the circumstances for lack of access (if any)
of large employers (or one or more classes of such
employers) in the State to such coverage.
``(2) Triennial reports to congress.--The Secretary, based
on the reports submitted under paragraph (1) and such other
information as the Secretary may use, shall prepare and submit
to Congress, every 3 years, a report describing the extent to
which large employers (and classes of such employers) that seek
health insurance coverage in the different States are able to
obtain access to such coverage. Such report shall include such
recommendations as the Secretary determines to be appropriate.
``(3) GAO report on large employer access to health
insurance coverage.--The Comptroller General shall provide for a
study of the extent to which classes of large employers in the
different States are able to obtain access to health insurance
coverage and the circumstances for lack of access (if any) to
such coverage. The Comptroller General shall submit to Congress
a report on such study not later than 18 months after the date
of the enactment of this title.
``(c) Special Rules for Network Plans.--
``(1) In general.--In the case of a health insurance issuer
that offers health insurance coverage in the small group market
through a network plan, the issuer may--
``(A) limit the employers that may apply for such
coverage to those with eligible individuals who live,
work, or reside in the service area for such network
plan; and
``(B) within the service area of such plan, deny
such coverage to such employers if the issuer has
demonstrated, if required, to the applicable State
authority that--
``(i) it will not have the capacity to deliver
services adequately to enrollees of any additional
groups because of its obligations to existing
group contract holders and enrollees, and
``(ii) it is applying this paragraph uniformly
to all employers without regard to the claims
experience of those employers and their employees
(and their dependents) or any health status-
related factor relating to such employees and
dependents.
``(2) 180-day suspension upon denial of coverage.--An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer coverage
in the small group market within such service area for a period
of 180 days after the date such coverage is denied.
``(d) Application of Financial Capacity Limits.--
``(1) In general.--A health insurance issuer may deny health
insurance coverage in the small group market if the issuer has
demonstrated, if required, to the applicable State authority
that--
``(A) it does not have the financial reserves
necessary to underwrite additional coverage; and
``(B) it is applying this paragraph uniformly to all
employers in the small group market in the State
consistent with applicable State law and without regard
to the claims experience of those employers and their
employees (and their dependents) or any health status-
related factor relating to such employees and
dependents.
``(2) 180-day suspension upon denial of coverage.--A health
insurance issuer upon denying health insurance coverage in
connection with group health plans in accordance with paragraph
(1) in a State may not offer coverage in connection with group
health plans in the small group market in the State for a period
of 180 days after the date such coverage is denied or until the
issuer has demonstrated to the applicable State authority, if
required under applicable State law, that the issuer has
sufficient financial reserves to underwrite additional coverage,
whichever is later. An applicable State authority may provide
for the application of this subsection on a service-area-
specific basis.
``(e) Exception to Requirement for Failure To Meet Certain Minimum
Participation or Contribution Rules.--
``(1) In general.--Subsection (a) shall not be construed to
preclude a health insurance issuer from establishing employer
contribution rules or group participation rules for the offering
of health insurance coverage in connection
with a group health plan in the small group market, as allowed under
applicable State law.
``(2) Rules defined.--For purposes of paragraph (1)--
``(A) the term `employer contribution rule' means a
requirement relating to the minimum level or amount of
employer contribution toward the premium for enrollment
of participants and beneficiaries; and
``(B) the term `group participation rule' means a
requirement relating to the minimum number of
participants or beneficiaries that must be enrolled in
relation to a specified percentage or number of eligible
individuals or employees of an employer.
``(f) Exception for Coverage Offered Only to Bona Fide Association
Members.--Subsection (a) shall not apply to health insurance coverage
offered by a health insurance issuer if such coverage is made available
in the small group market only through one or more bona fide
associations (as defined in section 2791(d)(3)).
``
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