Wyo. Code R. 044-0002-49
Chapter 49: Regulation to implement the Small Employer Health Insurance Availability Act
Effective Date: 10/13/2015 to Current
Rule Type: Current Rules & Regulations
Reference Number: 044.0002.49.10132015
SMALL EMPLOYER HEALTH INSURANCE
This Regulation is issued pursuant to the authority vested in the Commissioner under W.S. §§ 26-2-110, 26-19-304(a)(xii) and 26-19-310.
(a) For the purposes of this Regulation: 'Associate member of an employee organization' means any individual who participates in an employee benefit plan (as defined in 29 U.S.C. § 1002(1)) that is a multi-employer plan (as defined in 29 U.S.C. § 1002(37A)), other than the following:
(i) An individual, or the beneficiary of such individual, who is employed by a participating employer within a bargaining unit covered by at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained; or
(ii) An individual who is a present or former employee, or a beneficiary of such employee, of the sponsoring employee organization, of an employer who is or was a party to at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained, or of the employee benefit plan or of a related plan.
(b) 'New entrant' means an eligible employee, or the dependent of an eligible employee, if coverage is offered to the dependent, who becomes part of an employer group after the initial period for enrollment in a health benefit plan, and who enrolls on a timely basis within the prescribed enrollment period. If an eligible employee has continued coverage under the provisions of W.S. § 26-19-113, or under the provisions of applicable Federal law, and the continued coverage is voluntarily continued to, or is voluntarily terminated on, a date that is after the end of that person's prescribed initial enrollment period of a health benefit plan, that eligible employee and his or her dependents shall not be considered late enrollees, as defined in W.S. § 26-19-302(xv).
(c) 'Qualifying previous coverage' and 'qualifying existing coverage' means public or private benefits or coverage provided under:
(i) Medicare, Medicaid, the Wyoming Health Insurance Pool, or other health benefit programs or coverages operated or maintained by any governmental entity;
(ii) An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health plan; or (iii) An individual health benefit plan (including coverage issued by a health maintenance organization, prepaid hospital or medical care plan, or a fraternal benefit society) that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan.
(d) 'Risk characteristic' means the claims experience, duration of coverage, or any similar characteristic related to the experience of a small employer group or of any member of a small employer group.
(e) 'Risk load' means the percentage above the applicable base premium rate that is charged by a small employer carrier to a small employer to reflect the risk characteristics of the small employer group.
(a) This Regulation shall apply to any health benefit plan, whether provided on a group or individual basis, which:
(i) Meets one or more of the conditions set forth in W.S. § 26-19-303;
(ii) Provides coverage to two or more eligible employees of a small employer, without regard to whether the policy or certificate was issued in this state; and
(iii) Is in effect on or after the effective date of W.S. § 26-19-301 et seq.
(b) A carrier that provides an individual health benefit plan to two or more of the employees of a small employer shall be considered a small employer carrier and shall be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation with respect to such policies if the small employer contributes directly or indirectly to the premiums for the policies and the carrier is aware or should have been aware of such contribution as is explained in W.S. § 26-19-303.
(c) In the case of a carrier that provides individual health benefit plans to two or more employees of a small employer, the small employer shall be considered to be an eligible small employer as defined in W.S. § 26-19-302(a)(xxii) and the small employer carrier shall be subject to W.S. § 26-19-306(a) (relating to guaranteed issue of coverage) if:
(i) The small employer has at least two (2) employees;
(ii) The small employer contributes directly or indirectly to the premiums charged by the carrier; and (iii) The carrier is aware or should have been aware of the contribution by the employer.
(d) The provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan provided to a small employer or to the employees of a small employer without regard to whether the health benefit plan is offered under or provided through a group policy or trust arrangement of any size sponsored by an association or discretionary group.
(e) An individual health insurance policy shall not be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation solely because the policyholder elects a deduction under Section 162(l) of the Internal Revenue Code.
(i) If a small employer, as defined by applicable federal or state law, is issued a health benefit plan under the terms of W.S. § 26-19-301 et seq., the provisions of W.S. § 26-19-301 et seq. and this Regulation shall continue to apply to the health benefit plan in the case that the small employer subsequently employs more than the required number of eligible employees to be considered a small employer. A carrier providing coverage to such an employer shall, within sixty (60) days of becoming aware that the employer has more than the required number of eligible employees to be considered a small employer but no later than the anniversary date of the employer's health benefit plan, notify the employer that the protection provided under W.S. § 26-19-301 et seq. and this Regulation shall cease to apply to the employer if such employer fails to renew its current health benefit plan or elects to enroll in a different health benefit plan.
(ii) If a health benefit plan is issued to an employer that is not a small employer as defined in W.S. § 26-19-302(a)(xxii) or as defined by applicable federal or state law, but subsequently the employer becomes a small employer (due to the loss or change of work status of one or more eligible employees), the terms of W.S. § 26-19-301 et seq. shall not apply to the health benefit plan. The carrier providing a health benefit plan to such an employer shall not become a small employer carrier under the terms of W.S. § 26-19-301 et seq. solely because the carrier continues to provide coverage under the health benefit plan to the employer
(iii) A carrier providing coverage to an employer described in subparagraph (f)(ii), who becomes aware that the employer meets the requirements to be a small employer, as defined by applicable federal or state law, shall notify the employer within sixty (60) days of the options and protections available to the employer under W.S. § 26-19-301 et seq., including the employer's option to purchase a small employer health benefit plan from any small employer carrier.
(iv) If a small employer has employees in more than one state, the provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan issued to the small employer if:
(A) The majority of eligible employees of such small employer are employed in this state, or are residents of Wyoming; or
(B) If no state contains a majority of the eligible employees of the small employer, the primary business location for plan determination of the small employer shall be Wyoming.
(v) In determining whether the laws of Wyoming or another state apply to a health benefit plan issued to a small employer, the provisions of subparagraph (iv) shall be applied as of the plan issuance date.
(vi) If a health benefit plan is subject to W.S. § 26-19-301 et seq. and this Regulation, these provisions shall apply to all individuals covered under the health benefit plan, whether they reside in Wyoming or in another state.
(g) A carrier that is not operating as a small employer carrier in Wyoming shall not become subject to these provisions solely because a small employer that was issued a health benefit plan in another state by that carrier moves to Wyoming.
(a) A small employer carrier that establishes more than one class of business as defined in W.S. § 26-19-302(a)(vii) shall maintain on file for inspection by the Commissioner the following information:
(i) A description of each criterion employed by the carrier (or any of its agents) for determining membership in the class of business;
(ii) A statement describing the justification for establishing a separate class of business, and documentation substantiating differences in expected claims experience or administrative costs; and
(iii) A statement disclosing which, if any, health benefit plans are available in the class and any significant limitations related to the purchase of such plans.
(b) A carrier may not use group size as a criterion for establishing eligibility for a health benefit plan or for a class of business.
(a) A small employer carrier shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in Wyoming unless:
(i) The transaction has been approved by the Commissioner of the state of domicile of the assuming carrier;
(ii) The transaction has been approved by the Commissioner of the state of domicile of the ceding carrier; and
(iii) The transaction otherwise meets the requirements of this section.
(b) A carrier domiciled in Wyoming that proposes to assume or cede the entire insurance obligation and/or risk of one or more small employer health benefit plans from another carrier shall make a filing for approval with the Commissioner at least sixty (60) days prior to the date of the proposed transaction. The Commissioner may approve the transaction if the Commissioner finds that the transaction is in the best interests of the individuals insured under the health benefit plans to be transferred and is consistent with the purposes of W.S. § 26-19-301 et seq. and this Regulation. The Commissioner shall not approve the transaction until at least thirty (30) days after the date of the filing; except that, if the ceding carrier is in hazardous financial condition, the Commissioner may approve the transaction as soon as the Commissioner deems reasonable after the filing.
(c) The filing required under paragraph (b) above shall:
(i) Describe the class of business (including any eligibility requirements) of the ceding carrier from which the health benefit plans will be ceded;
(ii) Describe whether the assuming carrier will maintain the assumed health benefit plans as a separate class of business, pursuant to subsection (k), or will incorporate them into an existing class of business, pursuant to subsection (l). If the assumed health benefit plans will be incorporated into an existing class of business, the filing shall describe the class of business into which the health benefit plans will be incorporated;
(iii) Describe whether the health benefit plans being assumed are currently available for purchase by small employers;
(iv) Describe the potential effect of the assumption, if any, on the benefits provided by the health benefit plans to be assumed;
(v) Describe the potential effect of the assumption, if any, on the premiums for the health benefit plans to be assumed;
(vi) Describe any other potential material effects of the assumption on the coverage provided to the small employers covered by the health benefit plans to be assumed; and
(vii) Include any other information required by the Commissioner.
(d) A small employer carrier required to make a filing under subparagraph (b) above shall also make an informational filing with the Commissioner of each state in which there are small employer health benefit plans that would be included in the transaction. The informational filing to each state shall be made concurrently with the filing made under subparagraph (b) and shall include at least the information specified in subparagraph (c) for the small employer health benefit plans in that state.
(e) A small employer carrier shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in Wyoming unless:
(i) The carrier has provided notice to the Commissioner at least sixty (60) days prior to the date of the proposed assumption. The notice shall contain the information specified in subparagraph (c).
(f) If the assumption of a class of business would result in the assuming small employer carrier being out of compliance with the limitations related to premium rates contained in W.S. § 26-19-304(a)(i), the assuming carrier shall make a filing with the Commissioner pursuant to W.S. § 26-19-304(c) seeking suspension of the application of W.S. § 26-19-304(a)(i).
(g) An assuming carrier seeking suspension of the application of W.S. § 26-19-304(a)(i) shall not complete the assumption of health benefit plans covering small employers in Wyoming unless the Commissioner grants the suspension requested pursuant to subparagraph (f).
(h) Unless a different period is approved by the Commissioner, a suspension of the application of W.S. § 26-19-304(a)(i) shall, with respect to an assumed class of business, be for no more than fifteen (15) months and, with respect to each individual small employer, shall last only until the anniversary date of such employer's coverage (except that the period with respect to an individual small employer may be extended beyond its first anniversary date for a period of up to twelve (12) months if the anniversary date occurs within three (3) months of the date of assumption of the class of business).
(i) Except as provided in subparagraph (b), a small employer carrier shall not cede or assume the entire insurance obligation and/or risk for a small employer health benefit plan unless the transaction includes the ceding to the assuming carrier of the entire class of business which includes such health benefit plan.
(j) A small employer carrier may cede less than an entire class of business to an assuming carrier if:
(i) One or more small employers in the class have exercised their right under contract or Wyoming law to reject (either directly or by implication) the ceding of their health benefit plans to another carrier. In that instance, the transaction shall include each health benefit plan in the class of business except those health benefit plans for which a small employer has rejected the proposed cession; or
(ii) After a written request from the transferring carrier, the Commissioner determines that the transfer of less than the entire class of business is in the best interests of the small employers insured in that class of business.
(k) Except as provided in subsection (l), a small employer carrier that assumes one or more health benefit plans from another carrier shall maintain such health benefit plans as a separate class of business.
(l) A small employer carrier that assumes one or more health benefit plans from another carrier may exceed the limitation contained in W.S. § 26-19-302(a)(vii) (relating to the maximum number of classes of business a carrier may establish) due solely to such assumption for a period of up to fifteen (15) months after the date of the assumption, provided that the carrier complies with the following provisions:
(i) Upon assumption of the health benefit plans, such health benefit plans shall be maintained as a separate class of business. During the fifteen-month (15) period following the assumption, each of the assumed small employer health benefit plans shall be transferred by the assuming small employer carrier into a single class of business operated by the assuming small employer carrier. The assuming small employer carrier shall select the class of business into which the assumed health benefit plans will be transferred in a manner such that the transfer results in the least possible change to the benefits and rating method of the assumed health benefit plans.
(ii) The transfers authorized in subparagraph (a) shall occur with respect to each small employer on the anniversary date of the small employer's coverage, except that the period with respect to an individual small employer may be extended beyond its first anniversary date for a period of up to twelve (12) months if the anniversary date occurs within three (3) months of the date of assumption of the class of business.
(iii) A small employer carrier making a transfer pursuant to subparagraph (i) may alter the benefits of the assumed health benefit plans to conform to the benefits currently offered by the carrier in the class of business into which the health benefit plans have been transferred.
(iv) The premium rate for an assumed small employer health benefit plan shall not be modified by the assuming small employer carrier until the health benefit plan is transferred pursuant to subparagraph (i). Upon transfer, the assuming small employer carrier shall calculate a new premium rate for the health benefit plan from the rate manual established for the class of business into which the health benefit plan is transferred. In making such calculation, the risk load applied to the health benefit plan shall be no higher than the risk load applicable to such health benefit plan prior to the assumption.
(v) During the fifteen-month period provided in this subsection, the transfer of small employer health benefit plans from the assumed class of business in accordance with this subsection shall not be considered a violation of the first sentence of W.S. § 26-19-304(b).
(m) An assuming carrier may not apply eligibility requirements (including minimum participation and contribution requirements) with respect to an assumed health benefit plan (or with respect to any health benefit plan subsequently offered to a small employer covered by such an assumed health benefit plan) that are more stringent than the requirements applicable to such health benefit plan prior to the assumption.
(n) The Commissioner may approve a longer period of transition upon application of a small employer carrier. The application shall be made within sixty (60) days after the date of assumption of the class of business and shall clearly state the justification for a longer transition period.
(o) Nothing in this section or in W.S. § 26-19-301 et seq. is intended to:
(i) Reduce or diminish any legal or contractual obligation or requirement, including any obligation of the ceding or assuming carrier related to the transaction;
(ii) Authorize a carrier that is not admitted to transact the business of insurance in this state to offer or insure health benefit plans in this state; or
(iii) Reduce or diminish the protection related to an assumption reinsurance transaction otherwise provided by law.
(a) A small employer carrier shall develop a separate rate manual for each class of business. Base premium rates and new business premium rates charged to small employers by the small employer carrier shall be computed solely from the applicable rate manual developed pursuant to this subsection. To the extent that a portion of the premium rates charged by a small employer carrier is based on the carrier's discretion, the manual shall specify the criteria and factors considered by the carrier in exercising such discretion. The carrier shall also provide the Commissioner, upon request, the rate manual and any additional information or documentation specified in this Section.
(i) A small employer carrier that modifies the rating method used in the rate manual for a class of business shall maintain with the rate manual for a period of six (6) years information and documentation containing the following:
(A) The reasons the change in rating method is being modified;
(B) A complete description of each of the proposed modifications to the rating method;
(C) A description of how the change in rating method would affect the premium rates currently charged to small employers in the class of business, including an estimate from a qualified actuary of the number of groups or individuals (and a description of the types of groups or individuals) whose premium rates may change by more than ten percent (10%) due to the proposed change in rating method (not generally including increases in premium rates applicable to all small employers in a health benefit plan);
(D) A certification from a qualified actuary that the new rating method would be based on objective and credible data and would be actuarially sound and appropriate; and
(E) A certification from a qualified actuary that the proposed change in rating method would not produce premium rates for small employers that would be in violation of W.S. § 26-19-304.
(ii) For the purpose of this section a change in rating method shall mean:
(A) A change in the number of case characteristics used by a small employer carrier to determine premium rates for health benefit plans in a class of business;
(B) A change in the manner or procedures by which insureds are assigned into categories for the purpose of applying a case characteristic to determine premium rates for health benefit plans in a class of business;
(C) A change in the method of allocating expenses among health benefit plans in a class of business; or
(D) A change in a rating factor with respect to any case characteristic if the change would produce a change in premium for any small employer that exceeds ten percent (10%). A change in a rating factor shall mean the cumulative change with respect to such factor considered over a twelve (12) month period. If a small employer carrier changes rating factors with respect to more than one case characteristic in a twelve (12) month period, the carrier shall consider the cumulative effect of all such changes in applying the ten percent (10%) test.
(b) The rate manual developed pursuant to subsection (a) shall specify the case characteristics and rate factors to be applied by the small employer carrier in establishing premium rates for the class of business.
(c) A small employer carrier shall use the same case characteristics in establishing premium rates for each health benefit plan in a class of business and shall apply them in the same manner in establishing premium rates for each health benefit plan. Case characteristics shall be applied without regard to the risk characteristics of a small employer.
(d) The rate manual developed pursuant to subsection (a) shall clearly illustrate the relationship among the base premium rates charged for each health benefit plan in the class of business. If the new business premium rate is different than the base premium rate for a health benefit plan, the rate manual shall illustrate the difference.
(e) Differences among base premium rates for health benefit plans shall be based solely on the reasonable and objective differences in the design and benefits of the health benefit plans and shall not be based in any way on the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan. A small employer carrier shall apply case characteristics and rate factors within a class of business in a manner that assures that premium differences among health benefit plans for identical small employer groups vary only due to reasonable and objective differences in the design and benefits of the health benefit plans and are not due to the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan.
(f) Except as provided in subparagraph (g), a premium charged to a small employer for a health benefit plan shall not include a separate application fee, underwriting fee, or any other separate fee or charge.
(g) A carrier may charge a separate fee with respect to a health benefit plan (but only one fee with respect to such plan) provided the fee is no more than five dollars ($5.00) per month per employee and is applied in a uniform manner to each health benefit plan in a class of business, with such fee being included in determining the carrier's compliance with W.S. § 26-19-304.
(h) A small employer carrier shall allocate administrative expenses to the basic and standard health benefit plans on no less favorable of a basis than expenses are allocated to other health benefit plans in the class of business. The rate manual developed pursuant to subsection (a) shall describe the method of allocating administrative expenses to the health benefit plans in the class of business for which the manual was developed.
(i) Each rate manual, updates, and changes developed pursuant to subsection (a) shall be maintained by the carrier for a period of six (6) years.
(j) The rate manual and rating practices of a small employer carrier shall comply with any guidelines issued by the Commissioner.
(k) If group size is used as a case characteristic, the highest rate factor associated with a group size shall not exceed the lowest rate factor by more than 20 percent (20%).
(l) A small employer carrier shall revise its rate manual each rating period to reflect changes in base premium rates and changes in new business premium rates.
(m) A small employer carrier shall keep on file for a period of at least six (6) years the calculations used to determine the change in base premium rates and new business premium rates for each health benefit plan for each rating period.
(n) Changes in premium rates for a small employer shall be subject to the provisions in W.S. § 26-19-304.
(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.
(b) A producer shall:
(i) Notify a small employer carrier, prior to submitting an application for coverage with the carrier on behalf of a small employer, of any circumstances that would indicate that the small employer has induced or pressured an eligible employee or eligible dependent, if dependent coverage is offered, to decline coverage due to the individual's risk characteristics.
(a) Except as provided in subsections (b) and (c), a small employer carrier may not consider the trade or occupation of the employees of a small employer or the industry or type of business in which the small employer is engaged in determining whether to issue or continue to provide coverage to the small employer.
(b) A small employer carrier may use industry as a case characteristic in establishing premium rates, subject to applicable federal and state law.
(c) A small employer carrier may consider trade, occupation or industry as part of the eligibility criteria for a class of business, subject to applicable federal and state law.
(a) A carrier that has been prohibited from writing coverage for small employers in Wyoming pursuant to W.S. § 26-19-305(c) may not resume offering health benefit plans to small employers in Wyoming until the carrier has made a petition and has been approved by the Commissioner.
(b) In the case of a small employer carrier doing business in only one established geographic service area of Wyoming, if the small employer carrier elects to nonrenew a health benefit plan under W.S. § 26-19-305(a)(vi), the small employer carrier shall be prohibited from offering health benefit plans to small employers in any part of the service area for a period of five (5) years. In addition, the small employer carrier shall not offer health benefit plans to small employers in any other geographic area of the state without the prior approval of the Commissioner.
(a) For the purposes of W.S. § 26-19-302(a)(xv) and 26-19-306(c)(ii), an individual will be considered to have previous or existing coverage if the previous or existing policy, certificate or other benefit arrangement met the relevant definition of Section 2(c) of this Regulation. The small employer carrier shall interpret W.S. § 26-19-301 et seq. and this Regulation no less favorably to an insured individual than the following:
(i) A health insurance policy, certificate or other health benefit arrangement shall be considered employer-based if an employer sponsors the plan or arrangement or makes a contribution to the plan or arrangement.
(ii) A health insurance policy, certificate or other benefit arrangement shall be considered to provide benefits similar to or exceeding the benefits provided under the basic health benefit plan if it provides benefits that:
(A) Have an actuarial value as considered for a normal distribution of groups that is not substantially less than the actuarial value of the basic health benefit plan; or
(B) Provides coverage for hospitalization and physician services that is substantially similar to or exceeds the coverage for such services in the basic health benefit plan.
(b) In making a determination under subsection (a), a small employer carrier shall evaluate the previous or existing policy, certificate or other benefit arrangement taken as a whole and shall not base its decision solely on the fact that one portion of the previous or existing policy, certificate or benefit arrangement provides less coverage than the comparable portion of the basic health benefit plan.
(c) For the purposes of W.S. § 26-19-306(c)(ii), an individual will be considered to have qualifying previous coverage with respect to a particular service if the previous policy, certificate or other benefit arrangement met the definition in Section 2(c) of this Regulation and provided any benefit with respect to that service.
(d) A small employer carrier shall ascertain the source of previous or existing coverage of each eligible employee and each eligible dependent(s) if dependent coverage is offered at the time such employee or dependent initially enrolls into the health benefit plan. The small employer carrier shall contact the source of such previous or existing coverage to determine the benefits or limitations of the previous or existing coverage.
(a) Except as permitted in applicable federal and state law, a small employer carrier shall not modify or restrict a basic or standard health benefit plan in any manner for the purposes of restricting or excluding coverage or benefits for specific diseases, medical conditions or services otherwise covered by the plan.
(b) Except as permitted in applicable federal and state law, a small employer carrier shall not modify or restrict any health benefit plan with respect to any eligible employee or dependent of an eligible employee if dependent coverage is offered, through riders, endorsements or otherwise, for the purpose of restricting or excluding the coverage or benefits provided to such employee or dependent if dependent coverage is offered for specific diseases, medical conditions or services otherwise covered by the plan.
(a) A small employer carrier shall actively market each of its health benefit plans in Wyoming. A small employer carrier may not suspend the marketing or issuance of the basic and standard health benefit plans unless the carrier has good cause and has received the prior approval of the Commissioner.
(b) In marketing the basic and standard health benefit plans, a small employer carrier shall use at least the same sources and methods of distribution that it uses to market other health benefit plans. Any producer authorized by a small employer carrier to market health benefit plans in Wyoming shall also be authorized to market the basic and standard health benefit plans.
(c) A small employer carrier shall actively offer all health benefit plans actively marketed in Wyoming to any small employer that applies for or makes an inquiry regarding health insurance coverage. The offer shall be in writing and the offer may be provided directly to the small employer or delivered through a producer and shall include at least the following information:
(i) A general description of the benefits contained in the basic and standard health benefit plans and any other health benefit plan being offered to the small employer; and
(ii) Information describing how the small employer may enroll in the plans.
(d) A small employer carrier shall provide a price quote to a small employer directly or through an authorized producer within fifteen (15) working days of receiving a request for a quote and such information as is necessary to provide the quote. A small employer carrier shall notify a small employer directly or through an authorized producer within ten (10) working days of receiving a request for a price quote of any additional information needed to provide the quote.
(e) A small employer carrier may not apply more stringent or detailed requirements related to the application process for the basic and standard health benefit plans than are applied for other health benefit plans.
(f) The small group carrier shall not require a small employer to join or contribute to any association or group as a condition of being accepted for coverage, unless, membership in an association or other group is a requirement for accepting a small employer into a particular health benefit plan.
(g) A small employer carrier shall not require, as a condition to the offer or sale of a health benefit plan to a small employer, that the small employer purchase or qualify for any other insurance product or service.
(h) Carriers offering individual and group health benefit plans in Wyoming shall be responsible for determining whether the plans are subject to the requirements of W.S. § 26-19-301 et seq. and this Regulation. Carriers shall elicit the following information from applicants for such plans at the time of application:
(i) Whether or not any portion of the premium will be paid by or on behalf of a small employer, either directly or through wage adjustments or other means of reimbursement; and
(ii) Whether or not the prospective policyholder, certificate holder or any prospective insured individual intends to treat the health benefit plan as part of a plan or program under Section 162 (other than Section 162(l)), Section 125 or Section 106 of the United States Internal Revenue Code.
(i) If a small employer carrier fails to comply with subparagraph (h), the small employer carrier shall be deemed to be on notice of any information that could reasonably have been attained if the small employer carrier had complied with subparagraph (h).
(j) A small employer carrier shall file annually on or before March 15, in a format prescribed by the Commissioner, the following information related to health benefit plans issued by the small employer carrier to small employers in Wyoming:
(i) The number of small employers that were issued health benefit plans in the previous calendar year, separated as to newly issued plans and renewals;
(ii) The number of small employers that were issued the basic health benefit plan and the standard health benefit plan in the previous calendar year, separated as to newly issued plans and renewals;
(iii) The number of small employer health benefit plans in force in each county, or by zip code, of the state as of December 31 of the previous calendar year;
(iv) The number of small employer health benefit plans that were voluntarily not renewed by small employers in the previous calendar year;
(v) The number of small employer health benefit plans that were terminated or non-renewed for reasons other than nonpayment of premium by the carrier in the previous calendar year; and
(vi) The number of small employer health benefit plans that were issued to small employers that were uninsured for at least the three (3) months prior to issue.
(a) This regulation shall become effective upon filing with the Secretary of State.