* § 3231. Rating of individual and small group health insurance\npolicies; approval of superintendent. (a) (1) No individual health\ninsurance policy and no group health insurance policy covering between\none and fifty employees or members of the group or between one and one\nhundred employees or members of the group for policies issued or renewed\non or after January first, two thousand sixteen exclusive of spouses and\ndependents, hereinafter referred to as a small group, providing hospital\nand/or medical benefits, including medicare supplemental insurance,\nshall be issued in this state unless such policy is community rated and,\nnotwithstanding any other provisions of law, the underwriting of such\npolicy involves no more than the imposition of a pre-existing condition\nlimitation if otherwise permitted by this article. (2) Any individual,\nand dependents of such individual, and any small group, including all\nemployees or group members and dependents of employees or members,\napplying for individual health insurance coverage, including medicare\nsupplemental coverage, or small group health insurance coverage,\nincluding medicare supplemental insurance, but not including coverage\nissued on or after January first, two thousand fourteen, specified in\nsubsection (l) of section three thousand two hundred sixteen, of this\narticle must be accepted at all times throughout the year for any\nhospital and/or medical coverage offered by the insurer to individuals\nor small groups in this state. (3) Once accepted for coverage, an\nindividual or small group cannot be terminated by the insurer due to\nclaims experience. Termination of an individual or small group shall be\nbased only on one or more of the reasons set forth in subsection (g) of\nsection three thousand two hundred sixteen or subsection (p) of section\nthree thousand two hundred twenty-one of this article. Group hospital\nand/or medical coverage, including medicare supplemental insurance,\nobtained through an out-of-state trust covering a group of fifty or\nfewer employees, or between one and one hundred employees for policies\nissued or renewed on or after January first, two thousand sixteen, or\nparticipating persons who are residents of this state must be community\nrated regardless of the situs of delivery of the policy. Notwithstanding\nany other provisions of law, the underwriting of such policy may involve\nno more than the imposition of a pre-existing condition limitation if\npermitted by this article, and once accepted for coverage, an individual\nor small group cannot be terminated due to claims experience.\nTermination of an individual or small group shall be based only on one\nor more of the reasons set forth in subsection (p) of section three\nthousand two hundred twenty-one of this article. (4) For the purposes\nof this section, "community rated" means a rating methodology in which\nthe premium for all persons covered by a policy form is the same based\non the experience of the entire pool of risks of all individuals or\nsmall groups covered by the insurer without regard to age, sex, health\nstatus, tobacco usage or occupation, excluding those individuals or\nsmall groups covered by medicare supplemental insurance. For medicare\nsupplemental insurance coverage, "community rated" means a rating\nmethodology in which the premiums for all persons covered by a policy or\ncontract form is the same based on the experience of the entire pool of\nrisks covered by that policy or contract form without regard to age,\nsex, health status, tobacco usage or occupation.\n (b) (1) The superintendent may set standard premium tiers and standard\nrating relativities between tiers applicable to all policies subject to\nthis section. The superintendent may set a standard relativity\napplicable to child-only policies issued pursuant to section 1302(f) of\nthe affordable care act, 42 U.S.C. § 18022(f). The relativity for\nchild-only policies shall be actuarially justifiable
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