North Dakota Code 26.1-36-02.2 – Individual health plans – Open enrollment periods – Rules
1. As used in this section:
Terms Used In North Dakota Code 26.1-36-02.2
- Individual: means a human being. See North Dakota Code 1-01-49
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- year: means twelve consecutive months. See North Dakota Code 1-01-33
a. “Adverse selection” occurs when an individual who experiences greater than average health risks seeks to purchase an individual health plan.
b. “Annual open enrollment period” means a period each year during which an individual may enroll or change coverage in an individual health plan that is not sold through a health benefit exchange.
c. “Health benefit exchange” means a governmental agency or nonprofit entity that: (1) Meets the applicable requirements of the federal Patient Protection and Affordable Care Act [Pub. L. 111-148] and the provisions of the Health Care and Education Reconciliation Act of 2010 [Pub. L. 111-152]; and
(2) Makes qualified health plans available to qualified individuals and qualified employers through a state health benefit exchange, regional health benefit exchange, subsidiary health benefit exchange, or a federally facilitated health benefit exchange.
d. “Individual health plan” means health insurance coverage offered to individuals, other than in connection with a group health plan. The term does not include limited scope dental or vision benefits, coverage only for specified disease or illness, hospital indemnity or other fixed indemnity insurance, or other similar limited benefit health plans.
e. “Initial enrollment period” means a period during which an individual may enroll in individual health plan coverage sold outside a health benefit exchange for coverage during the 2014 benefit year.
f. “Special enrollment period” means a period that is outside of the initial and annual open enrollment periods, during which an individual or enrollee who experiences certain qualifying events may enroll in or change enrollment in an individual health plan not sold through a health benefit exchange.
2. The commissioner may adopt rules reasonably necessary to mitigate adverse selection or other undesirable market effect among individual health plans sold inside and among individual health plans sold outside a health benefit exchange. The rules may contain:
a. Requirements for the initial enrollment period; b. Requirements for an annual open enrollment period; c. Requirements for a special enrollment period; d. Requirements for an individual who purchases individual health plan coverage during a special enrollment period; and
e. Any other provision reasonably required to mitigate adverse selection or other undesirable market effect in individual health plans sold inside or outside a health benefit exchange.