Mississippi § 83-9-209 - Eligibility for coverage; maximum lifetime benefits; termination of coverage; unfair trade practice by insurers, agents or brokers, or employers.

§ 83-9-209. Eligibility for coverage; maximum lifetime benefits; termination of coverage; unfair trade practice by insurers, agents or brokers, or employers.

Any individual who is and continues to be a resident shall be eligible for coverage under this plan if evidence is provided of: A notice of rejection or refusal to issue health insurance coverage for health reasons by one (1) insurer; A refusal by an insurer to issue health insurance coverage except with material underwriting restriction; or A refusal by an insurer to issue health insurance coverage except at a rate exceeding the plan rate. The board shall develop a procedure for eligibility for coverage by the association for any natural person who changes his domicile to this state and who at the time domicile is established in this state is insured by an organization similar to the association. The eligible maximum lifetime benefits for such covered person shall not exceed the lifetime benefits available through the association, less any benefits received from a similar organization in the former domiciliary state. The board may promulgate a list of medical or health conditions for which a person shall be eligible for plan coverage without applying for health insurance coverage under subsection (1) of this section. Persons who can demonstrate the existence or history of any medical or health conditions on such list promulgated by the board may not be required to provide the evidence specified in subsection (1) of this section. Any such list previously promulgated by the board may be amended or repealed by the board from time to time as may be appropriate. A person shall not be eligible for coverage under this plan if: The person has or obtains health insurance coverage, or would be eligible to have coverage if the person elected to obtain it; except that: A person may maintain other coverage for the period of time the person is satisfying a preexisting condition waiting period under a plan policy; and A person may maintain plan coverage for the period of time the person is satisfying a preexisting condition waiting period under another health insurance policy intended to replace the plan policy. The person is determined to be eligible for health care benefits under the Mississippi Medicaid Law, Section 43-13-101 et seq., or Medicare. The person previously terminated plan coverage unless twelve (12) months have elapsed since the person’s latest termination. The plan has paid out One Million Dollars ($1,000,000.00) in benefits on behalf of the person. The lifetime maximum shall be One Million Dollars ($1,000,000.00). The person is an inmate or resident of a public institution. The person’s premiums are paid for or reimbursed under any government sponsored program or by any government agency or health care provider, except as an otherwise qualifying full-time employee, or dependent thereof, of a government agency or health care provider. The coverage of any person shall cease: On the date a person is no longer a resident of this state; Upon the death of the covered person; On the date state law requires cancellation of the policy; or At the option of the association, thirty (30) days after the association makes any inquiry concerning the person’s eligibility or place of residence to which the person does not reply. The coverage of any person who ceases to meet the eligibility requirements of this section may be terminated immediately. It shall constitute an unfair trade practice for any insurer, insurance agent or broker, employer or third-party administrator to refer an individual employee or a dependent of an individual employee to the association, or to arrange for an individual employee or a dependent of an individual employee to apply to the program, for the purpose of separating such employee or dependent from a group health benefits plan provided in connection with the employee’s employment.