(1) Group health benefit plans. (a) Every employer group health benefit plan issued by a carrier must contain a provision specifying that if a covered employee's employment is terminated and the health benefit plan remains in force for active employees of the employer, the covered employee whose employment is terminated may elect to continue the coverage for himself or herself and his or her dependents. The provision must conform to the requirements, where applicable, of paragraphs (b), (c), and (e) of this subsection (1).
(b) An employee is eligible to make the election described in paragraph (a) of this subsection (1) on the employee's own behalf and on behalf of eligible, covered dependents if:
The employee's eligibility to receive insurance coverage has ended for any reasonother than discontinuance of the group policy in its entirety or with respect to an insured class;
Any premium or contribution required from or on behalf of the employee has beenpaid through the employment termination date; and
The employee has been continuously covered under the group health benefit plan,or under any group health benefit plan providing similar benefits that it replaces, for at least six months immediately prior to termination.
The employer is not required to offer continuation of coverage to any person if theperson is covered by medicare, Title XVIII of the federal "Social Security Act", or medicaid, Title XIX of the federal "Social Security Act".
Once payment of disability benefits has started, a carrier shall not reduce benefitsdue under a policy of insurance insuring against disability from sickness or accident based on an increase in federal social security benefits.
(I) Upon the termination of employment of an eligible employee, the death of aneligible employee, or the change in marital or civil union status of an eligible employee, the employee or dependent has the right to continue the coverage for a period of eighteen months after loss of coverage or until the employee or dependent becomes eligible for other group coverage, whichever occurs first. However, should the new coverage exclude a condition covered under the continued plan, coverage under the prior employer's plan may be continued for the excluded condition only for eighteen months or until the new plan covers the condition, whichever occurs first.
(II) The employer shall notify the employee in writing of the employee's right to continue health care coverage upon termination from employment. A written communication signed by the employee or a notice postmarked within ten days after termination mailed by the employer to the last-known address of the employee satisfies the notice requirements of this subparagraph (II). The notification must inform the employee of:
The employee's right to elect to continue the existing coverage at the applicable rate;
The amount the employee must pay monthly to the employer to retain the coverage,which payment includes the employer's contribution for the employee in addition to the employee's own contribution;
The manner in which, and the office of the employer to which, the employee mustsubmit the payment to the employer;
The date and time by which the employee must submit the payments to the employerto retain coverage; and
The fact that the employee will lose the coverage if the employee does not timelysubmit the payment to the employer.
The employee shall notify the employer in writing of the employee's election tocontinue coverage and shall make proper payment to the employer as soon as possible upon notification by the employer of termination. In no case shall the employee submit the notification of election or the proper payment more than thirty days after the date of termination of employment unless the employer has failed to give timely notice in accordance with subparagraph (II) of this paragraph (e). If the employee timely submits the required payment and notice, the employee's health care coverage is continued as if there had been no interruption of coverage. If the employee fails to timely submit proper payment and notice, the employer is relieved of any responsibility to the employee for the continuation of health care coverage.
If the employer fails to notify an eligible employee of the right to elect to continuethe coverage, the employee has the option to retain coverage if, within sixty days after the date the employment is terminated, the employee makes the proper payment to the employer to provide continuous coverage.
After timely receipt of the monthly payment from an eligible employee, if the employer fails to make the payment to the carrier, with the result that the employee's coverage is terminated, the employer is liable for the employee's coverage, but to no greater extent than the amount of the premium.
(2) Group policies and group service contracts - reduction in hours of work. Every group policy or group service contract delivered or issued for delivery in this state by an insurer subject to part 2 of this article or by an entity subject to part 3 or 4 of this article that covers fulltime employees working forty or more hours per week shall contain a provision that the policyholder may elect to contract with the insurer or other entity to continue the policy or contract under the same conditions and for the same premium for the employees and their dependents even if the policyholder or employer reduces the working hours of the employees to less than thirty hours per week, if the following conditions are met:
The covered employee is employed as a full-time employee of the policyholder oremployer and is insured under the group policy or group service contract, or under any group policy or group service contract providing similar benefits that the group policy or group service contract replaces, immediately prior to the reduction in working hours;
The policyholder has imposed the reduction in working hours due to economic conditions or due to the employee's injury, disability, or chronic health conditions; and
The policyholder intends to restore the employee to a full forty-hour work scheduleas soon as economic conditions improve or as soon as the employee is able to return to full-time work.
Source: L. 92: Entire article R&RE, p. 1643, § 1, effective July 1; (1)(e)(I) and (2)(c)(I) amended, p. 1746, § 6, effective January 1, 1993. L. 94: (1)(a), IP(1)(c)(I), (1)(d)(I), (1)(e)(I), and (2)(c)(I) amended and (4) added, p. 1911, § 8, effective July 1; (1)(d)(II) to (1)(d)(VII), (1)(d)(XI), and (1)(d)(XII) repealed, p. 1920, § 14, effective July 1. L. 99: IP(1)(e)(II),
(1)(e)(III), (1)(e)(IV), IP(2)(c)(II), (2)(c)(III), and (2)(c)(IV) amended, p. 198, §§ 3, 4, effective January 1, 2000. L. 2008: (3) amended, p. 1232, § 1, effective May 27. L. 2013: Entire section R&RE, (HB 13-1266), ch. 217, p. 952, § 16, effective May 13.
Editor's note: The provisions of this section are similar to provisions of several former sections as they existed prior to 1992. For a detailed comparison, see the comparative tables located in the back of the index.