§ 4317. Rating of individual and small group health insurance\ncontracts. (a) (1) No individual health insurance contract and no group\nhealth insurance contract covering between one and fifty employees or\nmembers of the group, or between one and one hundred employees or\nmembers of the group for policies issued or renewed on or after January\nfirst, two thousand sixteen exclusive of spouses and dependents,\nincluding contracts for which the premiums are paid by a remitting agent\nfor a group, hereinafter referred to as a small group, providing\nhospital and/or medical benefits, including Medicare supplemental\ninsurance, shall be issued in this state unless such contract is\ncommunity rated and, notwithstanding any other provisions of law, the\nunderwriting of such contract involves no more than the imposition of a\npre-existing condition limitation if otherwise permitted by this\narticle. (2) Any individual, and dependents of such individual, and any\nsmall group, including all employees or group members and dependents of\nemployees or members, applying for individual or small group health\ninsurance coverage including Medicare supplemental insurance, but not\nincluding coverage issued on or after January first, two thousand\nfourteen specified in subsection (l) of section four thousand three\nhundred four, and section four thousand three hundred twenty-eight of\nthis chapter, must be accepted at all times throughout the year for any\nhospital and/or medical coverage offered by the corporation to\nindividuals or small groups in this state. (3) Once accepted for\ncoverage, an individual or small group cannot be terminated by the\ninsurer due to claims experience. Termination of coverage for\nindividuals or small groups may be based only on one or more of the\nreasons set forth in subsection (c) of section four thousand three\nhundred four or subsection (j) of section four thousand three hundred\nfive of this article. (4) For the purposes of this section, "community\nrated" means a rating methodology in which the premium for all persons\ncovered by a policy or contract form is the same, based on the\nexperience of the entire pool of risks of all individuals or small\ngroups covered by the corporation without regard to age, sex, health\nstatus, tobacco usage or occupation excluding those individuals of small\ngroups 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 contracts subject to\nthis section. The superintendent may also set a standard relativity\napplicable to child-only contracts issued pursuant to section 1302(f) of\nthe affordable care act, 42 U.S.C. § 18022(f). The relativity for\nchild-only contracts must be actuarially justifiable using the aggregate\nexperience of corporations to prevent the charging of unjustified\npremiums. The superintendent may adjust such premium tiers and\nrelativities periodically based upon the aggregate experience of\ncorporations issuing contract forms subject to this section. (2) A\ncorporation shall establish separate community rates for individuals as\nopposed to small groups. (3) If a corporation is required to issue a\ncontract to individual proprietors pursuant to subsection (f) of this\nsection, such contract shall be subject to the requirements of\nsubsection (a) of this section.\n (c) (1) The superintendent shall permit the use of separate community\nrates for reasonable geographic regions, which may, in a given case,\ninclude a single county. The regions shall be approved by the\nsuperintendent as part of the rate
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