§ 27-19.1-1 - Medical benefits for those who lose eligibility to participate.
SECTION 27-19.1-1
§ 27-19.1-1 Medical benefits for those wholose eligibility to participate. – (a) Whenever the employment of an insured member of a group hospital, surgical,or medical insurance plan is terminated because of involuntary layoff or death,or as a result of the workplace ceasing to exist, or the permanent reduction insize of the workforce, the benefits of the plan may be continued as provided inthis section for a period of up to eighteen (18) months from the terminationdate of the insured member, but in any event not to exceed the shorter of theperiod which represents the period of continuous employment precedingtermination with the employer under whose contract the member is insured or thetime from the termination date of the insured member until the member,surviving spouse of a deceased member, and any other dependent(s) of the memberwho were covered under the plan, becomes employed by another group and eligiblefor benefits under another group plan.
(b) The extended coverage for the period defined insubsection (a) of this section shall be available to the terminated member thesurviving spouse of a deceased member, and any other dependent(s) of the memberwho were covered under the plan, at the same monthly premium rate orsubscription fee for the group in which he or she was previously a member or ata monthly premium rate or subscription fee as may be in effect from time totime for the same group subsequent to his or her qualification under subsection(a) of this section. The terminated member, the surviving spouse of a deceasedmember, and any other dependent(s) of the member who were covered under theplan, shall not be required to pay more than a monthly premium rate orsubscription fee per month at one time.
(c) The involuntarily laid off member or other memberqualifying under subsection (a) of this section, the surviving spouse of adeceased member, and any other dependent(s) of the member who were coveredunder the plan, may elect to continue participation in the group plan withinthirty (30) days after the member's qualification under subsection (a) of thissection. The involuntarily laid off member, the surviving spouse of a deceasedmember, and any other dependent(s) of the member who were covered under theplan shall be responsible for the payment of monthly premiums rates orsubscription fees directly to the carrier of the surgical, hospital, or medicalinsurance plan, or the group plan's agent or insurance producer, throughout theextended coverage period, if the member had been covered under a group planconsisting of fifty (50) members or less. Those leaving group plans with morethan fifty (50) members shall be responsible directly to the employer for thepayment of monthly premiums rates or subscription fees, or directly to thecarrier if the workplace ceases to exist. The terminated member, the survivingspouse of a deceased member, and any other dependent(s) of the member who werecovered under the plan, shall not be required to pay more than a monthlypremium rate or subscription fee per month at one time.
(d) After timely receipt of the monthly premium rate orsubscription fee, as defined in this subsection, from the qualifying member,the surviving spouse of a deceased member, and any other dependent(s) of themember who were covered under the plan, if the employer fails to make paymentto the carrier with the result that coverage is terminated, the employer shallbe liable for benefits to the same extent as the carrier would have been liableif coverage had not been terminated. "Timely receipt" of the monthly premiumpayment means the employer's receipt of the monthly premium rate orsubscription fee for the extended coverage from the qualifying member, thesurviving spouse of a deceased member, and any other dependent(s) of the memberwho were covered under the plan within the dates or by the date indicated bythe employer as a requirement of this chapter at the time of the election ofthe extended coverage. This subsection shall not apply to an employer whoseworkplace ceases to exist.
(e) Upon termination of the extended coverage period, thequalifying member, the surviving spouse of a deceased member, and any otherdependent(s) of the member who were covered under the plan shall be entitled toexercise any option which is provided in the group plan to elect a convertedpolicy.
(f) All employers who provide their employees a grouphospital, surgical, or medical insurance plan shall post a conspicuous noticeto the employees of their options under the provisions of this chapter.
(g) "Group hospital, surgical, or medical insurance plan" asused herein in this section includes any service plan contract of a medical orhealth service plan corporation. "Carrier" as used in this section means shallmean any insurance company which is the insurer of the group hospital,surgical, or medical plan or the medical or health service plan corporationwhich provides the group service plan contract, either of which an employerprovides for his or her employees.
(h) This chapter shall not apply to an employee who isemployed in the construction industry or his or her employer if the employee,at the time benefits could be selected under this chapter, is a participant in,and the employer is a contributor to, a multi-employer welfare plan as definedin 29 U.S.C. § 1301 et seq., and which the internal revenue service hasdetermined is tax exempt as to contributions received and as to benefitsreceived by its participants.
(i) Notwithstanding any section to the contrary, any memberwho qualified for the extended coverage as defined in subsection (a) on orafter September 1, 2008 but who declined to elect coverage within the timeframeas described within subsection (c) may elect, no later than May 1, 2009, toresume coverage under this section. Coverage elected under this subsectionshall commence March 1, 2009 and may be continued as defined in subsection (a).