(a) General Exception for Certain Small Group Health Plans. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan for any plan year if, on the first day of the group health plan year, the group health plan has less than two (2) participants who are current employees.
(b) Exception for Certain Benefits. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage in relation to its provision of excepted benefits described in § 23-86-310(a).
(c) Exception for Certain Benefits if Certain Conditions Met. (1) Limited, Excepted Benefits. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in § 23-86-310(b) if the benefits:
(A) Are provided under a separate policy, certificate, or contract of insurance; or
(B) Are otherwise not an integral part of the group health plan.
(2) Noncoordinated, Excepted Benefits. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in § 23-86-310(c) if all of the following conditions are met:
(A) The benefits are provided under a separate policy, certificate, or contract of insurance;
(B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor; and
(C) Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor.
(3) Supplemental Excepted Benefits. The requirements of this subchapter shall not apply to any group health plan or group health insurance coverage in relation to its provision of excepted benefits described in § 23-86-310(d) if the benefits are provided under a separate policy, certificate, or contract of insurance.
(d) Treatment of Partnerships. (1) Treatment as a Group Health Plan. Any plan, fund, or program which would not be, but for this subsection, an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that the plan, fund, or program provides medical care, including items and services paid for as medical care, to present or former partners in the partnership or to their dependents, as defined under the terms of the plan, fund, or program, directly or through insurance or reimbursement or otherwise, shall be treated, subject to subdivision (d)(2) of this section, as an employee welfare benefit plan which is a group health plan.
(2) Employer. In the case of a group health plan, the term "employer" also includes the partnership in relation to any partner.
(3) Participants of Group Health Plans. In the case of a group health plan, the term "participant" also includes:
(A) In connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership; or
(B) In connection with a group health plan maintained by a self-employed individual under which one (1) or more employees are participants, the self-employed individual, if the individual is, or may become, eligible to receive a benefit under the group health plan or the individual's beneficiaries may be eligible to receive any such benefit.
Section: Previous 23-86-302 23-86-303 23-86-304 23-86-305 23-86-306 23-86-307 23-86-308 23-86-309 23-86-310 23-86-311 23-86-312 23-86-313 23-86-314 NextLast modified: November 15, 2016