(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:
(I)The employee's eligibility to receive insurance coverage has ended for any
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(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:
(I) The employee's eligibility to receive insurance coverage has ended for any
reason other than discontinuance of the group policy in its entirety or with respect
to an insured class;
(II) Any premium or contribution required from or on behalf of the employee
has been paid through the employment termination date; and
(III) 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.
(c) The employer is not required to offer continuation of coverage to any
person if the person is covered by medicare, Title XVIII of the federal Social
Security Act, or medicaid, Title XIX of the federal Social Security Act.
(d) Once payment of disability benefits has started, a carrier shall not reduce
benefits due under a policy of insurance insuring against disability from sickness or
accident based on an increase in federal social security benefits.
(e) (I) Upon the termination of employment of an eligible employee, the death
of an eligible 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:
(A) The employee's right to elect to continue the existing coverage at the
applicable rate;
(B) 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;
(C) The manner in which, and the office of the employer to which, the
employee must submit the payment to the employer;
(D) The date and time by which the employee must submit the payments to
the employer to retain coverage; and
(E) The fact that the employee will lose the coverage if the employee does
not timely submit the payment to the employer.
(III) The employee shall notify the employer in writing of the employee's
election to continue 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.
(IV) If the employer fails to notify an eligible employee of the right to elect to
continue the 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.
(V) 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 full-time 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:
(a) The covered employee is employed as a full-time employee of the
policyholder or employer 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;
(b) 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
(c) The policyholder intends to restore the employee to a full forty-hour work
schedule as soon as economic conditions improve or as soon as the employee is
able to return to full-time work.