Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.6 - Requirement to Insure Entire Group

Current through June 14, 2024
A. Coverage for
				  each eligible employee and dependent. A small employer carrier that offers
				  coverage to a small employer shall offer to provide coverage to each eligible
				  employee and to each dependent of an eligible employee. Except as provided in
				  §
										10.6(B)   of this Part, the small employer carrier shall provide the same
				  health benefit plan to each such employee and dependent.
B. Offering one or more health benefit plans.
				  A small employer carrier may offer the employees of a small employer the option
				  of choosing one or more health benefit plans, provided that each employee may
				  choose any of the offered plans. Except as provided in R.I. Gen. Laws §
										27-50-7(d) (with
				  respect to exclusions for preexisting conditions), the choice among benefit
				  plans may not be limited, restricted or conditioned based upon the risk
				  characteristics or a health status-related factor of the employees or their
				  dependents.
C. List of eligible
				  employees and dependents. A small employer carrier shall require each small
				  employer that initially applies for coverage, as part of the application
				  process, to provide a complete list of eligible employees and dependents of
				  eligible employees as defined in R.I. Gen. Laws §
										27-50-3(m). The
				  small employer carrier shall require the small employer to provide appropriate
				  supporting documentation (such as the W-2 Summary Wage and Tax Form) to verify
				  the information required hereunder. Thereafter, eligibility documentation shall
				  only be required for new employees and/or dependents who apply for coverage.
				  Complete recertification of all eligible employees and dependents, or
				  recertification of a particular employee and/or dependent may be required by
				  the carrier at any time.
D.
				  Waivers.
1. A small employer carrier shall
				  obtain a waiver from each eligible employee and each dependent of such an
				  eligible employee who declines an offer of coverage under a health benefit plan
				  provided to a small employer.
2.
				  The waiver shall be signed by the eligible employee (on behalf of such employee
				  or the dependent of such employee) and shall certify that the individual who
				  declined coverage was informed of the availability of coverage under the health
				  benefit plan.
3. The waiver form
				  shall:
a. require that the reason for
				  declining coverage be stated on the form;
b. include a written warning of the penalties
				  imposed on late enrollees;
c.
				  include a statement informing the eligible employee of their special enrollment
				  rights, if any, under R.I. Gen. Laws §
												27-50-7(d)(7) or
				  (8); and
d. include the model description of special
				  enrollment rights contained in Appendix A issued in a bulletin promulgated for
				  that purpose, or a substantially similar description.
4. In the event that an eligible employee or
				  dependent refuses to sign the waiver required hereunder, the small employer
				  must certify such refusal in writing.
5. Waivers and certifications of refusal to
				  sign waivers shall be maintained by the small employer carrier for a period of
				  six years.