§ 26-19-203 — Continuance of coverage where one carrier's contract replaces a plan of similar benefits of another carrier

Wyoming § 26-19-203

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 19: GROUP AND BLANKET DISABILITY INSURANCE

Text

(a) In those instances in which one (1) carrier's contract
replaces a plan of similar benefits of another carrier:
(i) The prior carrier remains liable only to the
extent of its accrued liabilities and extensions of benefits.
The position of the prior carrier shall be the same whether the
group policy holder or other entity secures replacement coverage
from a new carrier, self-insures or foregoes the provision of
coverage;
(ii) The succeeding carrier is liable under the
following circumstances:
(A) Each person covered under the prior
carrier's plan shall be eligible for complete coverage in
accordance with the succeeding carrier's plan of benefits, which
shall include coverage for ninety (90) days for any complication
caused as a result of a condition for which benefits were paid
under the prior plan within ninety (90) days prior to
termination of that plan. Copayment and deductible levels for
coverage required under this subparagraph may be applied in a
manner consistent with those provided by the succeeding
carrier's plan;
(B) In the case of a preexisting conditions
limitation included in the succeeding carrier's plan, the level
of benefits applicable to preexisting conditions of persons
becoming covered by the succeeding carrier's plan in accordance
with this paragraph during the period of time this limitation
applies under the new plan shall be the lesser of:
(I) The benefits of the new plan determined
without application of the preexisting conditions limitations;
or
(II) The benefits of the prior plan.
(C) In any situation where a determination of
the prior carrier's benefit is required by the succeeding
carrier, at the succeeding carrier's request the prior carrier
shall furnish a statement of the benefits available or pertinent
information, sufficient to permit verification of the benefit
determination or the determination itself by the succeeding
carrier. For the purposes of this section, benefits of the
prior plan will be determined in accordance with all of the
definitions, conditions and covered expense provisions of the
prior plan rather than those of the succeeding plan. The
benefit determination will be made as if coverage had not been
replaced by the succeeding carrier.