NAIC model law · NAIC model laws
INDIVIDUAL MARKET HEALTH INSURANCE COVERAGE MODEL ACT
Edition and licensing notes
Publisher. National Association of Insurance Commissioners (NAIC)
Status. NAIC model, © NAIC. Brief quotations under fair use; not the enacted law of any state until adopted.
What this document is
INDIVIDUAL MARKET HEALTH INSURANCE COVERAGE MODEL ACT is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.
Sections cited in practice questions
Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.
- Section 11A and 11B
“A. (1) Except as provided in Subsection B, health carriers offering health benefit plans providing individual market health insurance coverage shall not establish a lifetime limit on the dollar amount of essential health benefits for any individual. (2) (a) Except as provided in Subparagraph (b) of...”
- Section 6C(1)(b) and 6C(2)
“(b) Within the geographic service area for such network plan where the carrier reasonably anticipates, and demonstrates to the satisfaction of the Commissioner, that it will not have the capacity within its established geographic service area to deliver service adequately to any additional...”
- Section 6D
“D. (1) A health carrier described under Subsection A shall not be required to provide coverage if: (a) For any period of time the carrier demonstrates, and the Commissioner determines, the carrier does not have the financial reserves necessary to underwrite additional coverage; and (b) The carrier...”
- Section 6E(2)
“(2) This section shall not be construed to require that a health carrier offering health benefits plans only through one or more bona fide associations offer coverage in the individual market. However, if the health carrier offers health benefit plan bona fide association coverage in the individual...”
- Section 7C
“C. In any case in which a health carrier decides to discontinue offering a particular type of health benefit plan of individual market health insurance coverage, the health carrier may discontinue coverage in accordance with applicable state law only if the carrier: (1) Provides advance notice of...”
- Section 8B(2)
“(2) (a) A health carrier shall not deny or restrict coverage for a child who has not attained twenty-six (26) years of age based on a factor, such as the presence or absence of the child’s financial dependency upon the policyholder or any other person, residency with the policyholder or with any...”
Practice this material
Questions about this source
More NAIC model laws sources
- Health Carrier Prescription Drug Benefit Management Model ActNAIC model law
- INDIVIDUAL MARKET HEALTH INSURANCE COVERAGE MODEL REGULATIONNAIC model law
- Advertisements of Accident and Sickness Insurance Model RegulationNAIC model law
- Health Information Privacy Model ActNAIC model law
- Health Benefit Plan Network Access and Adequacy Model ActNAIC model law
- Health Carrier External Review Model ActNAIC model law
- MODEL HEALTH PLAN FOR UNINSURABLE INDIVIDUALS ACTNAIC model law
- STOP LOSS INSURANCE MODEL ACTNAIC model law