This section does not apply to a policy that primarily or solely supplements Medicare. The commissioner may adopt rules consistent with federal law to govern the discontinuance and replacement of plan policies that primarily or solely supplement Medicare. (a) (1) Every group policy entered into, amended, or renewed on or after September 1, 2003, that provides hospital, medical, or surgical expense benefits for employees or members shall provide that an employee or member whose coverage under the group policy has been terminated by the employer shall be entitled to convert to nongroup membership, without evidence of insurability, subject to the terms and conditions of this section. (2) If the health insurer provides coverage under an individual health insurance policy, other than conversion coverage under this part, it shall offer one of the two health insurance policies that the insurer is required to offer to a federally eligible defined individual pursuant to Section 10785. The health insurer shall provide this coverage at the same rate established under Section 10901.3 for a federally eligible defined individual. (3) If the health insurer does not provide coverage under an individual health insurance policy, it shall offer a health benefit plan contract that is the same as a health benefit contract offered to a federally eligible defined individual pursuant to Section 1366.35. The health insurer shall offer the most popular preferred provider organization plan that has the greatest number of enrolled individuals for its type of plan as of January 1 of the prior year, as reported by plans by January 31, 2003, and annually thereafter, that provide coverage under an individual health care service plan contract to the department or the Department of Managed Health Care. A health insurer subject to this paragraph shall provide this coverage with the same cost-sharing terms and at the same premium as a health care service plan providing coverage to that individual under an individual health care service plan contract pursuant to Section 1399.805. The health insurer shall file the health benefit plan contract it will offer, including the premium it will charge and the cost-sharing terms of the contract, with the Department of Insurance. (b) A conversion policy shall not be required to be made available to an employee or insured if termination of his or her coverage under the group policy occurred for any of the following reasons: (1) The group policy terminated or an employerâs participation terminated and the insurance is replaced by similar coverage under another group policy within 15 days of the date of termination of the group coverage or the employerâs participation. (2) The employee or insured failed to pay amounts due the health insurer. (3) The employee or insured was terminated by the health insurer from the policy for good cause. (4) The employee or insured knowingly furnished incorrect information or otherwise improperly obtained the benefits of the policy. (5) The employerâs hospital, medical, or surgical expense benefit program is self-insured. (c) A conversion policy is not required to be issued to any person if any of the following facts are present: (1) The person is covered by or is eligible for benefits under Title XVIII of the United States Social Security Act. (2) The person is covered by or is eligible for hospital, medical, or surgical benefits under any arrangement of coverage for individuals in a group, whether insured or self-insured. (3) The person is covered for similar benefits by an individual policy or contract. (4) The person has not been continuously covered during the three-month period immediately preceding that personâs termination of coverage. (d) Benefits of a conversion policy shall meet the requirements for benefits under this chapter. (e) Unless waived in writing by the insurer, written application and first premium payment for the conversion policy shall be made not later than 63 d
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