CurrentNorth Dakota Insurance DepartmentPolicy 21

Chapter 26–39 of North Dakota Century Code: Mental Illness and Addiction Coverage Administration

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Administrative interpretations for applying Chapter 26–39 requirements to qualifying group, blanket, franchise, and association policies covering North Dakota residents, including implementation timing, claims handling, and pre-existing-condition exclusions.

Policy Summary

PayerNorth Dakota Insurance Department

PolicyChapter 26–39 of North Dakota Century Code: Mental Illness and Addiction Coverage Administration

Policy CodePolicy N/A

Change TypeAdministrative interpretation

Effective DateJuly 1, 1975

Next Review DateNot specified

Key ActionInsurers must ensure that each new qualifying policy or plan conforms at inception to Chapter 26–39 requirements and applicable Department bulletins.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

NDState whose residents are expressly covered by the interpretation

4Policy and claims administration directives stated in the bulletin

InceptionConformity timing for new qualifying policies or plans

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CurrentNorth Dakota Insurance DepartmentPolicy 21

Chapter 26–39 of North Dakota Century Code: Mental Illness and Addiction Coverage Administration

Customize your policy alerts

Sign up for North Dakota Insurance Department Policy 21 alerts

Get alerted when Policy 21 changes without checking for updates manually.

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Policy Summary

PayerNorth Dakota Insurance Department

PolicyChapter 26–39 of North Dakota Century Code: Mental Illness and Addiction Coverage Administration

Policy CodePolicy N/A

Change TypeAdministrative interpretation

Effective DateJuly 1, 1975

Next Review DateNot specified

Key ActionInsurers must ensure that each new qualifying policy or plan conforms at inception to Chapter 26–39 requirements and applicable Department bulletins.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

NDState whose residents are expressly covered by the interpretation

4Policy and claims administration directives stated in the bulletin

InceptionConformity timing for new qualifying policies or plans

Applicability and Administrative Requirements

Applicability to North Dakota residents

Chapter 26–39 applies when all of the following conditions are met:

ALL of the following

The insured is a North Dakota resident.
Coverage is provided under a group or blanket policy, or under a franchise or association plan.
For a policy or plan delivered, issued, executed, renewed, or negotiated outside North Dakota, the applicable number-of-persons calculation is applied with respect to North Dakota residents only.

Policy conformity and claims administration

Qualifying policies and plans must satisfy all of the following requirements:

ALL of the following

Each new qualifying policy or plan conforms at inception to Chapter 26–39 and applicable Department bulletins.
Each existing qualifying policy or plan conforms on the next applicable policy anniversary date; for a franchise or association plan, each individual policy covering one or more North Dakota residents conforms on that anniversary date.
Required coverage is administered for claims as though it had been effective from the applicable required coverage date, even while revised policies, riders, endorsements, certificates, or similar documents are being developed or printed.
Any applicable pre-existing-condition exclusion applies from the applicable required coverage or policy or certificate effective date.

Implementation and Claims Handling

Documentation Required

Implement required coverage in new policies

Ensure that each new qualifying group, blanket, franchise, or association policy or plan conforms at inception to Chapter 26–39 requirements and applicable Departmental Bulletins.

Documentation Required

Update existing policies at anniversary

Bring each existing qualifying policy or plan into conformity on the applicable policy anniversary date. For a franchise or association plan, each individual policy covering one or more North Dakota residents must conform on that anniversary date.

Policy Summary

PayerNorth Dakota Insurance Department

PolicyChapter 26–39 of North Dakota Century Code: Mental Illness and Addiction Coverage Administration

Policy CodePolicy N/A

Change TypeAdministrative interpretation

Effective DateJuly 1, 1975

Next Review DateNot specified

Key ActionInsurers must ensure that each new qualifying policy or plan conforms at inception to Chapter 26–39 requirements and applicable Department bulletins.

SourceLink

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