Section 420-G:8 Open Enrollment and Late Enrollment.
I. Each small employer group shall have an annual open enrollment period 60 days in length, occurring prior to the small employer group's anniversary date. During open enrollment, employees or eligible dependents may apply to the small employer for health coverage or make a change in their membership status becoming effective upon the small employer group's anniversary date, subject to providing the health carrier 30-days notice.
(a) A health carrier shall not refuse any small employer employees or eligible dependents applying for health coverage during the open enrollment period.
(b) [Repealed.]
(c) Employees or eligible dependents coming on at the time of an open enrollment period shall have the same premiums as the rest of the small employer group shall have upon the new or renewal effective date.
I-a. Small employers who are self-employed individuals shall have 2 open enrollment periods that shall occur during the months of March and September of each calendar year. During these periods, health carriers shall make their plans available to these employers for effective dates beginning on the first day of the month following the open enrollment period. Self-employed individuals who seek coverage during other times of the year shall be treated as late enrollees.
II. A small employer employee who has met any employer imposed waiting period and is otherwise eligible for health coverage, who declines a small employer's health coverage plan during the initial offering or subsequent open enrollment period, shall be a late enrollee and shall not be allowed on the plan until the next open enrollment period.
II-a. Notwithstanding the provisions of paragraphs I-a and II, small employers who are self-employed individuals shall have 90 days from the date their business is first established to enroll in a plan. Health carriers shall make their plans available to such individuals for effective dates beginning on the first day of the month following enrollment.
III. A large employer employee, who has met any employer imposed waiting period and is otherwise eligible for health coverage, may enroll within 31 days of becoming eligible and shall not be required to submit evidence of insurability based on medical conditions. If a person does not enroll at this time, that person is a late enrollee.
(a) Each large employer group shall have an open enrollment period during which late enrollees may enroll and shall not be required to submit evidence of insurability based on medical conditions.
(b) For late enrollees in a large employer group only, a preexisting condition exclusion period may extend up to 18 months after the effective date of the person's health coverage.
IV. Paragraphs II and III notwithstanding, an eligible employee or eligible dependent shall not be considered a late enrollee if:
(a) The person was covered under public or private health coverage at the time the person was able to enroll; and
(1) Has lost public or private health coverage as a result of termination of employment or eligibility, the termination of the other plan's coverage, death of a spouse, or divorce; and
(2) Requests enrollment within 30 days after termination of such health coverage; or
(b) Is employed by an employer that offers multiple health coverages and the person elects a different plan during an open enrollment period; or
(c) Was ordered by a court to provide health coverage for an ex-spouse or a minor child under a covered employee's plan and request for enrollment is made within 30 days after issuance of such court order.
V. (a) If a large or small employer group's health coverage plan offers dependent coverage and the employee is enrolled or has met any applicable waiting period and is eligible to be enrolled, but for a failure to do so during a previous open enrollment period, a person who becomes a dependent of the employee through marriage, birth, adoption or placement for adoption, and the employee if not otherwise enrolled, shall be provided with a special enrollment period.
(b) The special enrollment period shall be at least 30 days in length and shall begin on the later of:
(1) The date dependent health coverage is made available; or
(2) The date of the marriage, birth, adoption or placement for adoption, as the case may be.
(c) If the person seeks enrollment during the first 30 days of such special enrollment period, the health coverage shall become effective:
(1) In the case of marriage, on or before the first day of the first month following the completed request for enrollment;
(2) In the case of birth, as of the date of birth; or
(3) In the case of adoption or placement for adoption, the date of such adoption or placement for adoption.
Source. 1997, 344:1. 2001, 296:3. 2003, 188:16, eff. Jan. 1, 2004. 2007, 289:39, eff. Jan. 1, 2008.