Current through September 21, 2024
(a) This Regulation shall apply to any health
benefit plan, whether provided on a group or individual basis, which:
(i) Meets one or more of the conditions set
forth in W.S. §
26-19-303;
(ii) Provides coverage to two or more
eligible employees of a small employer, without regard to whether the policy or
certificate was issued in this state; and
(iii) Is in effect on or after the effective
date of W.S. §
26-19-301 et seq.
(b) A carrier that provides an individual
health benefit plan to two or more of the employees of a small employer shall
be considered a small employer carrier and shall be subject to the provisions
of W.S. §
26-19-301 et seq. and this Regulation with
respect to such policies if the small employer contributes directly or
indirectly to the premiums for the policies and the carrier is aware or should
have been aware of such contribution as is explained in W.S. §
26-19-303.
(c) In the case of a carrier that provides
individual health benefit plans to two or more employees of a small employer,
the small employer shall be considered to be an eligible small employer as
defined in W.S. §
26-19-302(a)(xxii) and the
small employer carrier shall be subject to W.S. § 26 - 19 - 306(a)
(relating to guaranteed issue of coverage) if:
(i) The small employer has at least two (2)
employees;
(ii) The small employer
contributes directly or indirectly to the premiums charged by the carrier;
and
(iii) The carrier is aware or
should have been aware of the contribution by the employer.
(d) The provisions of W.S. §
26-19-301 et seq. and this Regulation shall
apply to a health benefit plan provided to a small employer or to the employees
of a small employer without regard to whether the health benefit plan is
offered under or provided through a group policy or trust arrangement of any
size sponsored by an association or discretionary group.
(e) An individual health insurance policy
shall not be subject to the provisions of W.S. §
26-19-301 et seq. and this Regulation solely
because the policyholder elects a deduction under Section 162(l) of the
Internal Revenue Code.
(f) Change
in Employer Status:
(i) If a small employer,
as defined by applicable federal or state law, is issued a health benefit plan
under the terms of W.S. §
26-19-301 et seq., the provisions of W.S.
§
26-19-301 et seq. and this Regulation shall
continue to apply to the health benefit plan in the case that the small
employer subsequently employs more than the required number of eligible
employees to be considered a small employer. A carrier providing coverage to
such an employer shall, within sixty (60) days of becoming aware that the
employer has more than the required number of eligible employees to be
considered a small employer but no later than the anniversary date of the
employer's health benefit plan, notify the employer that the protection
provided under W.S. §
26-19-301 et seq. and this Regulation shall
cease to apply to the employer if such employer fails to renew its current
health benefit plan or elects to enroll in a different health benefit plan.
(ii) If a health benefit plan is
issued to an employer that is not a small employer as defined in W.S. §
26-19-302(a)(xxii) or as
defined by applicable federal or state law, but subsequently the employer
becomes a small employer (due to the loss or change of work status of one or
more eligible employees), the terms of W.S. §
26-19-301 et seq. shall not apply to the
health benefit plan. The carrier providing a health benefit plan to such an
employer shall not become a small employer carrier under the terms of W.S.
§
26-19-301 et seq. solely because the carrier
continues to provide coverage under the health benefit plan to the
employer
(iii) A carrier providing
coverage to an employer described in subparagraph (f)(ii) , who becomes aware
that the employer meets the requirements to be a small employer, as defined by
applicable federal or state law, shall notify the employer within sixty (60)
days of the options and protections available to the employer under W.S. §
26-19-301 et seq., including the employer's
option to purchase a small employer health benefit plan from any small employer
carrier.
(iv) If a small employer
has employees in more than one state, the provisions of W.S. §
26-19-301 et seq. and this Regulation shall
apply to a health benefit plan issued to the small employer if:
(A) The majority of eligible employees of
such small employer are employed in this state, or are residents of Wyoming;
or
(B) If no state contains a
majority of the eligible employees of the small employer, the primary business
location for plan determination of the small employer shall be
Wyoming.
(v) In
determining whether the laws of Wyoming or another state apply to a health
benefit plan issued to a small employer, the provisions of subparagraph (iv)
shall be applied as of the plan issuance date.
(vi) If a health benefit plan is subject to
W.S. §
26-19-301 et seq. and this Regulation, these
provisions shall apply to all individuals covered under the health benefit
plan, whether they reside in Wyoming or in another state.
(g) A carrier that is not operating as a
small employer carrier in Wyoming shall not become subject to these provisions
solely because a small employer that was issued a health benefit plan in
another state by that carrier moves to Wyoming.
