Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.
1. If a carrier offers a contract to a voluntary purchasing group, the carrier shall offer the same coverage to all of the eligible employees of the small employers that are members of the voluntary purchasing group and their dependents. A carrier shall not offer coverage to only certain members of that group or to only part of that group, but may exclude an otherwise eligible employee, or his dependent, who requests enrollment in the contract after the end of the initial period during which the employee or dependent is entitled to enroll under the terms of the contract, if the initial period is at least 30 days.
2. A carrier shall not exclude an eligible employee or dependent if:
(a) The employee or dependent:
(1) Was covered under other creditable coverage at the time of the initial period for enrollment;
(2) Lost coverage under the other creditable coverage as a result of termination of employment or eligibility, the involuntary termination of the creditable coverage, the death of a spouse or divorce; and
(3) Requests enrollment within 30 days after termination of the other creditable coverage;
(b) The employee is employed by an employer that offers multiple contracts and elects a different contract during an open period for enrollment; or
(c) A court has ordered that coverage be provided for a dependent under a covered employee’s contract and the request for enrollment is made within 30 days after issuance of the court order.
Last modified: February 27, 2006