§ 27-18.6-6. Applicability — Exclusion of certain plans.
(a) The requirements of this chapter do not apply to any group health plan (and health
insurance coverage offered in connection with a group health plan) for any plan year
if, on the first day of the plan year, the plan does not meet the definition of large
employer and is subject to the provisions of chapter 50 of this title.
(b)(1) The requirements of this chapter apply with respect to group health plans only:
(i) In the case of a plan that is a nonfederal governmental plan; and
(ii) With respect to group health insurance coverage offered in connection with a group
health plan (including a plan that is a church plan or a governmental plan).
(2) If the plan sponsor of a nonfederal governmental plan which is a group health plan
to which this chapter otherwise applies makes an election (in the form and manner
as the secretary of the United States Department of Health and Human Services may
prescribe by regulation), then the requirements of this subsection (b) insofar as
they apply directly to group health plans (and not merely to group health insurance
coverage) do not apply to those governmental plans for the period except as provided
in this section.
(3) An election applies for a single specified plan year (which may be extended through
subsequent elections), or in the case of a plan provided pursuant to a collective
bargaining agreement, for the term of that agreement.
(4) Under the election in subsection (b)(3), the plan shall provide for notice to enrollees
(on an annual basis and at the time of enrollment under the plan) of the fact and
consequences of the election, and certification and disclosure of creditable coverage
under the plan with respect to enrollees in accordance with §â€‚27-18.6-3(i).
(c) The requirements of this chapter do not apply to any group health plan (and group
health insurance coverage offered in connection with a group health plan) in relation
to its provision of limited, excepted benefits if the benefits are provided under
a separate policy, certificate, or contract of insurance, or are not an integral part
of the plan.
(d) The requirements of this chapter do not apply to any group health plan (and group
health insurance coverage offered in connection with a group health plan) in relation
to its provision of noncoordinated, excepted benefits if all of the following conditions
are met:
(1) The benefits are provided under a separate policy, certificate, or contract of insurance;
(2) There is no coordination between the provision of benefits and any exclusion of benefits
under any group health plan maintained by the same plan sponsor; and
(3) The benefits are paid with respect to an event without regard to whether benefits
are provided with respect to that event under any group health plan maintained by
the same plan sponsor.
(e) The requirements of this chapter do not apply to any group health plan (and group
health insurance coverage) in relation to its provision of supplemental, excepted
benefits if the benefits are provided under a separate policy, certificate, or contract
of insurance.
(f)(1) For purposes of this chapter, any plan, fund, or program that would not be (but for
this subsection) an employee welfare benefit plan and that is established or maintained
by a partnership, to the extent that the plan, fund, or program provides medical care
(including items and services paid as medical care) to present or former partners
in the partnership or to their dependents (as defined under the terms of the plan,
fund, or program), directly or through insurance, reimbursement, or otherwise, shall
be treated as an employee welfare benefit plan that is a group health plan.
(2) In the case of a group health plan, the term "employer� also includes the partnership
in relation to any partner.
(3) In the case of a group health plan, the term "participant� also includes:
(i) In connection with a group health plan maintained by a partnership, an individual
who is a partner in relation to the partnership; or
(ii) In connection with a group health plan maintained by a self-employed individual (under
which one or more employees are participants), the self-employed individual, if that
individual is, or may become, eligible to receive a benefit under the plan or the
individual's beneficiaries may be eligible to receive any benefits.