(a)A carrier may not establish rules for eligibility of an individual to enroll under a group health benefit plan based on any health status-related factor.
(b)Subsection (a) of this section does not:
(1)require a carrier to provide particular benefits other than those provided under the terms of the particular health benefit plan; or
(2)prevent a carrier from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the health benefit plan.
(c)Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.
(d)A carrier shall allow an employee or dependent who is eligible, but not enroll
Free access — add to your briefcase to read the full text and ask questions with AI
(a) A carrier may not establish rules for eligibility of an individual to enroll under a group health benefit plan based on any health status-related factor.
(b) Subsection (a) of this section does not:
(1) require a carrier to provide particular benefits other than those provided under the terms of the particular health benefit plan; or
(2) prevent a carrier from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the health benefit plan.
(c) Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.
(d) A carrier shall allow an employee or dependent who is eligible, but not enrolled, for coverage under the terms of a group health benefit plan to enroll for coverage under the terms of the plan if:
(1) the employee or dependent was covered under an employer-sponsored plan or group health benefit plan at the time coverage was previously offered to the employee or dependent;
(2) the employee states in writing, at the time coverage was previously offered, that coverage under an employer-sponsored plan or group health benefit plan was the reason for declining enrollment, but only if the plan sponsor or issuer requires the statement and provides the employee with notice of the requirement;
(3) the employee’s or dependent’s coverage described in item (1) of this subsection:
(i) was under a COBRA continuation provision, and the coverage under that provision was exhausted; or
(ii) was not under a COBRA continuation provision, and either the coverage was terminated as a result of loss of eligibility for the coverage, including loss of eligibility as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or employer contributions towards the coverage were terminated; and
(4) under the terms of the plan, the employee requests enrollment not later than 30 days after:
(i) the date of exhaustion of coverage described in item (3)(i) of this subsection; or
(ii) termination of coverage or termination of employer contributions described in item (3)(ii) of this subsection.