044-49 Wyo. Code R. §§ 49-7 - Requirement to Insure Entire Groups
(a) A small employer carrier:
(i) That offers coverage to a small employer
shall offer to provide coverage to each eligible employee and may offer
coverage to each dependent of an eligible employee. Except as provided in
paragraph (ii), the small employer carrier shall provide the same health
benefit plan to each employee and eligible dependent(s);
(ii) May offer the employees the option of
choosing among one or more health benefit plans, provided that each employee
may choose any of the offered plans. The choice among benefit plans may not be
limited, restricted or conditioned based upon the risk characteristics of the
employees or their dependents, unless allowed by applicable federal or state
law;
(iii) Shall require each small
employer that applies for coverage, as part of the application process, to
provide a complete list of eligible employees and dependents, if offered, as
defined in applicable federal or state law. Employees who are listed as being
in their waiting period, probationary period or other period with similar
limitations of coverage must be identified, including the ending date for each
employee's period of limitation. Any subsequent lists submitted to the carrier
shall also contain the information required in this section. The carrier shall
require the employer to provide appropriate supporting documentation to verify
the information required under this paragraph;
(iv) Shall secure a waiver with respect to
each eligible employee and eligible dependents if dependent coverage is offered
who declines an offer of coverage. The waiver shall be signed by the eligible
employee or by the employee on behalf of the eligible dependent(s). The waiver
shall certify that the individual who declined coverage was informed of the
availability of coverage under the health benefit plan. The waiver form shall
include the reason for declining coverage ,a written warning of the penalties
imposed on late enrollees and a statement informing of any special enrollment
rights, as allowed by applicable federal or state law. Waivers shall be
maintained by the carrier for a period of six (6) years;
(v) Shall not issue coverage to a small
employer that refuses to provide the list required under subparagraph (iii) or
a waiver required under subparagraph (iv);
(vi) Shall not issue coverage to a small
employer if the carrier, or the carrier's producer, has reason to believe that
the small employer has induced or pressured an eligible employee or eligible
dependent, if dependent coverage is offered, to decline coverage due the
individual's risk characteristics.
(vii) Shall offer new entrants to a small
employer group an opportunity to enroll in the health benefit plan. A new
entrant who does not exercise the opportunity to enroll in the health benefit
plan within the period provided by the small employer carrier may be treated as
a late enrollee by the carrier, provided that the period provided to enroll in
the health benefit plan extends at least thirty (30) days after the date the
new entrant is notified of his or her opportunity to enroll. If a small
employer carrier has offered more than one health benefit plan to a small
employer group pursuant to subsection (a)(ii), the new entrant shall be offered
the same choice of health benefit plans as the other members of the
group.
(viii) Shall not apply a
waiting period, elimination period or other similar limitation of coverage
unless allowed by applicable federal and state law.
(ix) Shall accept new entrants for coverage
by the small employer carrier without any restrictions or limitations on
coverage related to the risk characteristics of the employees or their
dependents if dependent coverage is offered, except that a carrier may exclude
coverage for preexisting medical conditions, if allowed by applicable federal
or state law.
(x) May assess a risk
load to the premium rate associated with a new entrant, consistent with the
requirements of W.S. §
26-19-304. The risk load shall be the same
risk load charged to the small employer group immediately prior to acceptance
of the new entrant.
(b)
A producer shall:
(i) Notify a small employer
carrier, prior to submitting an application for coverage with the carrier on
behalf of a small employer, of any circumstances that would indicate that the
small employer has induced or pressured an eligible employee or eligible
dependent, if dependent coverage is offered, to decline coverage due to the
individual's risk characteristics.
Notes
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