044-49 Wyo. Code R. §§ 49-14 - Rules Related to Fair Marketing

(a)

(i) A small employer carrier shall actively market each of its health benefit plans to small employers in this state. A small employer carrier may not suspend the marketing or issuance of the basic and standard health benefit plans unless the carrier has good cause and has received the prior approval of the Commissioner.

(ii) In marketing the basic and standard health benefit plans to small employers, a small employer carrier shall use at least the same sources and methods of distribution that it uses to market other health benefit plans to small employers. Any producer authorized by a small employer carrier to market health benefit plans to small employers in the state shall also be authorized to market the basic and standard health benefit plans.

(b)

(i) A small employer carrier shall offer at least the basic and standard health benefit plans to any small employer that applies for or makes an inquiry regarding health insurance coverage from the small employer carrier. The offer shall be in writing and the offer may be provided directly to the small employer or delivered through a producer and shall include at least the following information:

(A) A general description of the benefits contained in the basic and standard health benefit plans and any other health benefit plan being offered to the small employer; and

(B) Information describing how the small employer may enroll in the plans.

(ii)

(A) A small employer carrier shall provide a price quote to a small employer (directly or through an authorized producer) within fifteen (15) working days of receiving a request for a quote and such information as is necessary to provide the quote. A small employer carrier shall notify a small employer (directly or through an authorized producer) within ten (10) working days of receiving a request for a price quote of any additional information needed by the small employer carrier to provide the quote.

(B) A small employer carrier may not apply more stringent or detailed requirements related to the application process for the basic and standard health benefit plans than are applied for other health benefit plans offered by the carrier.

(iii)

(A) If a small employer carrier denies coverage under a health benefit plan to a small employer on the basis of a risk characteristic, the denial shall be in writing and shall state with specificity the reasons for the denial (subject to any restrictions related to confidentiality of medical information). The written denial shall be accompanied by a written explanation of the availability of the basic and standard health benefit plans from the small employer carrier. The explanation shall include at least the following:

(I) A general description of the benefits contained in each such plan;

(II) A price quote for each such plan; and

(III) Information describing how the small employer may enroll in such plans.

(B) The written information described in subparagraph (A) may be provided within the time periods provided in paragraph (ii) directly to the small employer or delivered through an authorized producer.

(C) The price quote required under subparagraph (A)(II) shall be for the lowest-priced basic and standard health benefit plan for which the small employer is eligible.

(c) The small group carrier shall not require a small employer to join or contribute to any association or group as a condition of being accepted for coverage by the small employer carrier, except that, if membership in an association or other group is a requirement for accepting a small employer into a particular health benefit plan, a small employer carrier may apply such requirement.

(d) A small employer carrier may not require, as a condition to the offer or sale of a health benefit plan to a small employer, that the small employer purchase or qualify for any other insurance product or service.

(e)

(i) Carriers offering individual and group health benefit plans in this state shall be responsible for determining whether the plans are subject to the requirements of W . S . § 26-19-301 et seq. and this Regulation. Carriers shall elicit the following information from applicants for such plans at the time of application:

(A) Whether or not any portion of the premium will be paid by or on behalf of a small employer, either directly or through wage adjustments or other means of reimbursement; and

(B) Whether or not the prospective policyholder, certificate holder or any prospective insured individual intends to treat the health benefit plan as part of plan or program under Section 162 (other than Section 162(l)), Section 125 or Section 106 of the United States Internal Revenue Code.

(ii) If a small employer carrier fails to comply with paragraph (i), the small employer carrier shall be deemed to be on notice of any information that could reasonably have been attained if the small employer carrier had complied with paragraph (i).

(f)

(i) A small employer carrier shall file annually the following information with the Commissioner related to health benefit plans issued by the small employer carrier to small employers in this state:

(ii) The information in paragraph (i) shall be filed with the commissioner on or before March 15. Such filing shall be in the format and, at a minimum, contain the information the commissioner prescribes. Such filing shall be made in conjunction with the information specified under Section 7(g) of this Regulation. The format and required information may be obtained from the Wyoming Insurance Department.

(g)

(i) Failure of the small group carrier to comply with the provisions of this section may subject such carrier to administrative action by the Wyoming Department of Insurance.

Notes

044-49 Wyo. Code R. §§ 49-14