Required provisions in health benefit plan of employer who employs less than 20 employees related to continuation of coverage.
1. Except as otherwise provided in this section, if an employer who employs less than 20 employees maintains a health benefit plan which covers those employees, the plan must contain a provision which permits:
(a) An employee to elect to continue identical coverage under the plan, excluding coverage provided for eye or dental care, if:
(1) His employment is terminated for any reason other than gross misconduct; or
(2) The number of his working hours is reduced so that he ceases to be eligible for coverage.
(b) The spouse or dependent child of an employee to elect to continue coverage, excluding any coverage provided for eye or dental care, if:
(1) The employee’s employment is terminated for any reason other than gross misconduct or the number of his working hours is reduced so that he ceases to be eligible for coverage;
(2) The employee dies;
(3) The employee and his spouse are divorced or legally separated;
(4) The dependent child ceases to be eligible for coverage under the terms of the policy; or
(5) The spouse ceases to be eligible for coverage after becoming eligible for Medicare.
2. The period of continued coverage is limited to:
(a) Eighteen months for an employee.
(b) Thirty-six months for the dependent of an employee.
3. An employee who voluntarily leaves his employment, or the dependent of that employee, is not eligible to continue coverage pursuant to this section.
4. An employee or his dependent who has not been covered under a health benefit plan of the employer for at least 12 consecutive months before the termination of his coverage is not eligible to continue coverage pursuant to this section.
5. A provision for continued coverage must include coverage for any child born to, legally adopted by or placed for adoption with the employee during the period of continued coverage. Such a child is eligible for continued coverage only to the end of the period of continued coverage as established pursuant to subsection 2.
Last modified: February 27, 2006