Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-7 - Requirement to Insure Entire Groups

Current through July 13, 2024
(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.