Required provision concerning coverage for enrollee on leave without pay as result of total disability.
1. As used in this section, “total disability” and “totally disabled” mean the continuing inability of the enrollee, because of an injury or illness, to perform substantially the duties related to his employment for which he is otherwise qualified.
2. No policy of group insurance to which an enrollee is entitled under a health care plan provided by a health maintenance organization may be delivered or issued for delivery in this state unless it provides continuing coverage for an enrollee and his dependents who are otherwise covered by the policy while the enrollee is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the enrollee which is not related to the total disability or for any injury or illness suffered by his dependent. The coverage must be equal to or greater than the coverage otherwise provided by the policy.
3. The coverage required pursuant to subsection 2 must continue until:
(a) The date on which the employment of the enrollee is terminated;
(b) The date on which the enrollee obtains another policy of health insurance;
(c) The date on which the policy of group insurance is terminated; or
(d) After a period of 12 months in which benefits under such coverage are provided to the enrollee,
Ê whichever occurs first.
Last modified: February 27, 2006