33-30-16. Requirement to offer reasonably priced comprehensive major medical health insurance policy.

As used in this Code section, the term:#

1. (1)

   “Operative date” means the date on which either of the following occurs:#

   1. (A)

      A federal law is enacted which expressly repeals 42 U.S.C. Section 300gg-3 or 42 U.S.C. Section 300gg-4 of the PPACA; or#

   2. (B)

      42 U.S.C. Section 300gg-3 or 42 U.S.C. Section 300gg-4 of the PPACA is invalidated by the United States Supreme Court.#

2. (2)

   “PPACA” means the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152.#

3. (3)

   “Preexisting medical condition” means a condition that was present before the effective date of coverage under a policy, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage. Such term includes a condition identified as a result of a preenrollment questionnaire or physical examination given to the individual or a review of medical records relating to the preenrollment period.#

1. (1)

   Not later than 30 days after the operative date, and notwithstanding any other law to the contrary, every insurer issuing, delivering, or issuing for delivery comprehensive individual major medical health insurance policies in this state shall make at least one reasonably priced comprehensive major medical health insurance policy available to residents in the insurer’s approved service areas of this state, and such insurer may not exclude, limit, deny, or delay coverage under such policy due to one or more preexisting medical conditions.#

2. (2)

   Such insurer may not limit or exclude benefits under such policy, including a denial of coverage applicable to an individual as a result of information relating to an individual’s health status before the individual’s effective date of coverage, or if coverage is denied, before the date of the denial.#

The comprehensive major medical health insurance policy that the insurer is required to offer under this Code section shall be a policy that had been actively marketed in this state by the insurer as of the operative date and that was also actively marketed in this state during the year immediately preceding the operative date.#