(a)Exception for Certain Small Group Health Plans. The requirements of § 23-86-304 , limitation on preexisting conditions, § 23-86-306 , prohibiting discrimination based on health status, § 23-86-311 , guaranteed renewability, § 23-86-312 , guaranteed availability, and § 23-86-313 , disclosure of information, of this subchapter shall not apply to any group health plan and health insurance coverage offered in connection with a group health plan for any group health plan year if, on the first day of the group health plan year, the group health plan has fewer than two (2) participants who are current employees.
(b)Limitation on Application of Provisions Relating to Group Health Plans.
(1)In General. The requirements of §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 shall apply with r
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(a) Exception for Certain Small Group Health Plans. The requirements of § 23-86-304 , limitation on preexisting conditions, § 23-86-306 , prohibiting discrimination based on health status, § 23-86-311 , guaranteed renewability, § 23-86-312 , guaranteed availability, and § 23-86-313 , disclosure of information, of this subchapter shall not apply to any group health plan and health insurance coverage offered in connection with a group health plan for any group health plan year if, on the first day of the group health plan year, the group health plan has fewer than two (2) participants who are current employees. (b) Limitation on Application of Provisions Relating to Group Health Plans. (1) In General. The requirements of §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 shall apply with respect to group health plans only: (A) Subject to subdivision (b)(2) of this section, in the case of a group health plan that is a nonfederal governmental plan; and (B) With respect to health insurance coverage offered in connection with a group health plan including such a plan that is a church plan or a governmental plan. (2) Treatment of Nonfederal Governmental Plans. (A) Election to be Excluded. If the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 otherwise apply makes an election under this subdivision (b)(2)(A), then the requirements of those sections insofar as they apply directly to group health plans, and not merely to group health insurance coverage, shall not apply to the governmental plans for such a period except as provided in this subsection. (B) Period of Election. An election under subdivision (b)(2)(A) of this section shall apply: (i) For a single specified plan year; or (ii) In the case of a plan provided pursuant to a collective bargaining agreement, for the term of the agreement. An election under subdivision (b)(2)(B)(i) of this section may be extended through subsequent elections under this subdivision (b)(2)(B). (C) Notice to Enrollees. Under such an election, the plan shall provide for: (i) Notice to enrollees on an annual basis and at the time of enrollment under the plan of the fact and consequences of such an election; and (ii) Certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with § 23-86-304(e) . (c) Exception for Certain Benefits. The requirements of §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 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)(1) . (d) Exception for Certain Benefits if Certain Conditions Met. (1) Limited, Excepted Benefits. The requirements of §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 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 §§ 23-86-304 , 23-86-306 , and 23-86-311 - 23-86-313 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) The 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 subsection 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.