Eligibility; prohibiting cancellation because of eligibility for certain benefits




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20137820-1378.  Eligibility; prohibiting cancellation because of eligibility for certain benefits

A.  Except as specifically provided in sections 20 1379 and 20 1380, with respect to the determination of whether a person is an eligible individual, an insurer issuing disability insurance contracts shall not consider the availability of or a person's eligibility for medical assistance pursuant to title XIX of the social security act (P.L. 89 97; 79 Stat. 344; 42 United States Code section 1396a (1980)) when considering eligibility for coverage or calculating payments under its plans for eligible policyholders.

B.  To the extent that payment for covered expenses has been made under the state program pursuant to title XIX of the social security act for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for those health care items or services. On presentation of proof that the state program pursuant to title XIX of the social security act has paid for covered items or services, the insurer shall make payments to the state program pursuant to title XIX of the social security act according to the coverage provided in the disability insurance policy.

C.  An insurer issuing disability insurance contracts may not impose on a state agency that has been assigned the rights of an individual who is eligible for medical assistance and who is covered for health benefits from the insurer any requirements that are different from the requirements applicable to an agent or assignee of any other covered individual.



D.  An insurer issuing disability insurance contracts shall not cancel or fail to renew the contract of any person based on that person's eligibility for or enrollment in a program funded under title XIX of the social security act or title 36, chapter 29 or 34.  Nothing in this section prohibits cancellation or failure to renew for nonpayment of monies due under the contract.201378



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