§ 26.1-36-26 — Dual choice option on group health coverage - Minimum conditions - Transfer of coverage

Transfer of coverage.
If an existing or prospective employer group desires a dual choice option between a
nonprofit health service corporation or an insurance company and a health maintenance
organization, the dual choice option may be made available to the employees in the group only
if all of the following conditions are met:
1. There are at least fifteen employees in the group.
2. The group shall maintain the highest enrollment percentage as specified in the
underwriting manual of the nonprofit health service corporation, the insurance
company, or the health maintenance organization, and the health maintenance
organization enrollees must be combined with subscribers of nonprofit health service
corporations or insureds of insurance companies in meeting the percentage
requirements.
3. An employee must be allowed to transfer between coverage offered by a health
maintenance organization and coverage offered by a nonprofit health service
organization or insurance company on the group's anniversary date as specified in the
master contract with the group, except a special opening must be offered at the
group's request for the following reasons:
a. Upon a group's initial offering of a dual choice plan in addition to existing
coverages offered by a nonprofit health service corporation or an insurance
company.
b. When a group discontinues offering a dual choice plan with a health maintenance
organization to request open enrollment into the group offered by the nonprofit
health service corporation or the insurance company.

c. If the group offers both coverage by a nonprofit health service corporation or an
insurance company and a health maintenance organization and an individual
employee enrolled in the health maintenance organization transfers within the
same company but leaves the service area of the health maintenance
organization, the employee must be allowed to enroll in the plan offered by the
nonprofit health service corporation or the insurance company at the time of
transfer.
d. Any group that offers health coverage to its retired employees by a nonprofit
health service corporation or an insurance company and a health maintenance
organization must advise the employees who are enrolled under their present
coverage that they may change to other coverage offered at the time of
retirement, and if the employees who retire elect to retain or change their present
coverage, the employees will no longer be eligible to change coverage after
retirement.