§ 26-43-103 — Eligibility

Wyoming § 26-43-103

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 43: HEALTH CARE

Text

(a) Except as provided in subsections (b) and (e) of this
section, any individual person who is a resident of this state
is eligible for pool coverage under eligibility level one (1) or
eligibility level two (2) if evidence of the following is
provided:
(i) Rejection of or refusal to issue health insurance
for health reasons by one insurer;
(ii) Refusal to issue health insurance except at a
rate exceeding the applicable pool rate for the coverage applied
for under the pool; or
(iii) Refusal to issue health insurance except with a
reduction or exclusion of coverage for a preexisting health
condition which reduction or exclusion is more restrictive than
the reduction or exclusion provided by the applicable pool
coverage for which application is being made.
(b) The following persons are not eligible for pool
coverage:
(i) Persons who have coverage under health insurance
or an insurance arrangement on the issue date of pool coverage;
(ii) Any person who is at the time of pool
application eligible for Medicaid health care benefits or any
person who is eligible for Medicare by reason of age;
(iii) Any person who terminated coverage in the pool
unless twelve (12) months have elapsed from the termination
date;
(iv) Any person on whose behalf the pool has paid two
hundred fifty thousand dollars ($250,000.00) in benefits. The
board shall adjust these amounts annually to reflect the effects
of inflation. The adjustment shall not be less than the annual
change in the medical component of the "Consumer Price Index for
All Urban Consumers" of the department of labor, bureau of
statistics, unless the board proposes and the commissioner
approves a lower adjustment factor;
(v) Inmates of public institutions;
(vi) Persons who are eligible for group health
insurance or a group health insurance arrangement provided in
connection with a policy, plan or program sponsored by an
employer and subject to regulation as a group health plan under
federal or state law, even though the employer coverage is
declined, unless:
(A) The cost to insure the individual is offered
at a rate to the individual or his employed family member
exceeding the applicable pool rate by at least twelve and one-
half percent (12.5%) for the coverage applied for under the
pool; and
(B) At the time of enrollment, plan enrollment
does not exceed ninety-five percent (95%) of maximum enrollment
capacity as determined under W.S. 26-43-114.
(c) Repealed by Laws 2019, ch. 16, § 2.
(d) For purposes of catastrophic health insurance pursuant
to W.S. 26-43-106(b)(vi), in addition to the requirements of
subsection (a) of this section, eligibility shall be limited to
those individuals whose total household income does not exceed
four hundred percent (400%) of the federal poverty level.
(e) Notwithstanding subsection (a) of this section, the
commissioner shall have authority to terminate eligibility and
disenroll from coverage under the pool some or all of the
individuals who are enrolled in the plan as of July 1, 2015,
subject to the following:
(i) The commissioner has determined that all
individuals or groups of individuals who are to be disenrolled
have reasonable access to health insurance;
(ii) All individuals who are to be disenrolled shall
receive prior notice of disenrollment at least ninety (90) days
prior to the effective date of the disenrollment;
(iii) The commissioner shall have authority to
reenroll any individual or group who were disenrolled pursuant
to this subsection if it is demonstrated that the individual or
group cannot otherwise be insured at reasonable expense.