Free Group Health Insurance Study Guide
North Dakota Life, Accident & Health exam — Group Health Insurance.
Group underwriting, federal COBRA, HIPAA and the ACA group rules are covered in the national Group Health Insurance guide. This guide covers North Dakota's group accident and health rules in N.D.C.C. 26.1-36-05 to 26.1-36-26:
- standard group provisions
- state continuation, which lasts 39 weeks
- former-spouse continuation
- dual choice
- the coordination of benefits rule in N.D. Admin. Code 45-08-01.2
Standard group provisions (26.1-36-05)
| Provision | North Dakota rule |
|---|---|
| Grace period | 31 days |
| Statements | A statement can't be used to contest coverage unless a copy was given to the person who made it |
| Preexisting conditions | Look-back of no more than 12 months. The limitation ends after 12 treatment-free months or two years of coverage, whichever is earlier |
| Misstatement of age | An equitable adjustment of premium or benefits |
| Certificates | Each insured person gets a certificate describing the protection and to whom benefits are paid |
| Claim payment | No more than 60 days after proof of loss |
| Crime exclusion | Losses from committing or attempting a crime may be excluded, with a statutory exception for certain misdemeanors |
Mandated offers (26.1-36-06). Group, blanket, franchise and association medical coverage must offer prescription drug and chiropractic coverage at the policyholder's option.
State continuation (26.1-36-23)
- Eligibility. The employee must have been insured during the whole three months before termination.
- Not available to someone covered by Medicare, or by other group coverage they didn't have before termination.
- Election. The employee makes a written request within 10 days. No election is allowed more than 31 days after termination.
- Cost. No more than the group rate for the coverage.
- What's continued. Dental, vision and prescription drug benefits needn't be included.
- Length. Coverage ends 39 weeks after it would otherwise have ended, or sooner for nonpayment or if the plan ends.
- After continuation. The person may elect conversion coverage and pay within 31 days after continued coverage ends.
- Notice. Every certificate must describe the continuation privilege.
Former spouses (26.1-36-23.1)
- A former spouse may continue coverage until remarriage or another terminating event, for up to 36 months, at no more than 102% of the group premium.
- Conversion coverage is then available without evidence of insurability if the former spouse applies within 30 days after notice.
Dual choice (26.1-36-26)
North Dakota's dual choice law requires:
- at least 15 employees
- combined participation requirements
- transfers between plans on the group's anniversary date, with special openings for listed events
Coordination of benefits (N.D. Admin. Code 45-08-01.2-05)
- Non-dependent first. The plan covering the person as an employee (not as a dependent) is primary. There's a reversal rule for some Medicare situations.
- Children of married parents. The birthday rule applies: the parent whose birthday (month and day only) comes earlier in the year.
- Divorced parents, with no court decree:
- custodial parent
- custodial parent's spouse
- noncustodial parent
- noncustodial parent's spouse
- Active before retired. An active employee's plan is primary over a retired or laid-off employee's plan.
- Continuation is secondary. Coverage as an employee is primary over COBRA or state continuation.
- Longer coverage. If nothing else decides, the plan that covered the person longer is primary.
Common exam traps
- North Dakota state continuation lasts 39 weeks, not 18 months. It costs no more than the group rate.
- A former spouse may continue up to 36 months at 102%.
- Under the birthday rule, only the month and day matter, never the year.
- Group policies must offer prescription drug and chiropractic coverage.
- A group claim must be paid within 60 days of proof.
Practice Group Health Insurance questions All Life, Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
