Page:United States Statutes at Large Volume 110 Part 3.djvu/233

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PUBLIC LAW 104-191—AUG. 21, 1996 110 STAT. 1963 and submit to Congress, every 3 years, a report describing the extent to which large employers (and classes of such employ- ers) that seek health insurance coverage in the different States are able to obtain access to such coverage. Such report shall include such recommendations as the Secretary determines to be appropriate. " (3) GAG REPORT ON LARGE EMPLOYER ACCESS TO HEALTH INSURANCE COVERAGE.— The Comptroller General shall provide for a study of the extent to which classes of large employers in the different States are able to obtain access to health insurance coverage Jind the circumstances for lack of access (if any) to such coverage. The Comptroller General shall submit to Congress a report on such study not later than 18 months after the date of the enactment of this title. "(c) SPECLVL RULES FOR NETWORK PLANS.— "(1) IN GENERAL.—In the case of a health insurance issuer that offers health insurance coverage in the small group market through a network plan, the issuer may— "(A) limit the employers that may apply for such coverage to those with eligible individuals who live, work, or reside in the service area for such network plsm; and "(B) within the service area of such plein, deny such coverage to such employers if the issuer has demonstrated, if required, to the applicable State authority that— "(i) it will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees, and "(ii) it is applying this paragraph uniformly to all employers without regard to the claims experience of those employers and their employees (and their dependents) or any health status-related factor relating to such employees and dependents. "(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE. —An issuer, upon denying health insurance coverage in any service area in accordance with paragraph (1)(B), may not offer coverage in the small group market within such service area for a period of 180 days after the date such coverage is denied. " (d) APPLICATION OF FINANCIAL CAPACITY LIMITS.— "(1) IN GENERAL.. —A health insurance issuer may deny health insureince coverage in the small group market if the issuer has demonstrated, if required, to the applicable State authority that— "(A) it does not have the financial reserves necessary to underwrite additional coverage; and "(B) it is applying this paragraph imiformly to all employers in the small group market in the State consistent with applicable State law and without regard to the claims experience of those employers and their employees (and their dependents) or any health status-related factor relating to such employees and dependents. "(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with paragraph (1) in a State may not offer coverage in connection with group health plans in the small group market in the State for a period of 180 days after the date such coverage