CHAPTER 15. SMALL EMPLOYER GROUP HEALTH INSURANCE
IC 27-8-15
Chapter 15. Small Employer Group Health Insurance
IC 27-8-15-1
Application of chapter
Sec. 1. This chapter applies to any individual or group healthinsurance plan that is issued for delivery in Indiana to at least three(3) employees of a small employer located in Indiana if one (1) of thefollowing conditions is met:
(1) Any part of the premium or benefits is paid by a smallemployer or any covered individual is reimbursed, whetherthrough wage adjustments or otherwise, by a small employer forany part of the premium not including the administrativeexpenses of administering a payroll deduction plan where theemployee contributes one hundred percent (100%) of thepremium without reimbursement.
(2) The health benefit plan is treated by the employer or any ofthe covered individuals as part of a plan or program forpurposes of Section 106 or 162 of the United States InternalRevenue Code.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-2
Individual health insurance provisions; application
Sec. 2. The provisions of IC 27-8-5 concerning individualinsurance contracts do not apply to individual health insurancepolicies that are subject to this chapter.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-3
"Actuarial certification" defined
Sec. 3. As used in this chapter, "actuarial certification" means awritten statement by a member of the American Academy ofActuaries that a small employer insurer is in compliance with section16 of this chapter, based upon the person's examination, including areview of the appropriate records and of the actuarial assumptionsand methods utilized by the insurer in establishing premium rates forapplicable health insurance plans.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-4
"Base premium rate" defined
Sec. 4. As used in this chapter, "base premium rate" means thelowest premium rate charged or that could have been charged undera rating system by the small employer insurer to small employerswith similar case characteristics and benefit design characteristics.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-5
"Benefit design characteristics" defined Sec. 5. As used in this chapter, "benefit design characteristics"means the following:
(1) Covered services.
(2) Cost sharing.
(3) Utilization management.
(4) Managed care networks.
(5) Any other features differentiating plan or benefit design.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-6
"Case characteristics" defined
Sec. 6. As used in this chapter, "case characteristics" meansdemographic or other relevant characteristics of a small employer, asdetermined by a small employer insurer, that are considered by theinsurer in the determination of premium rates for the small employer.Claim experience, health status, and duration of coverage since issueare not case characteristics.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-7
"Commissioner" defined
Sec. 7. As used in this chapter, "commissioner" refers to thecommissioner of the department of insurance.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-8
"Department" defined
Sec. 8. As used in this chapter, "department" refers to thedepartment of insurance.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-8.5
"Eligible employee" defined
Sec. 8.5. (a) As used in this chapter, "eligible employee" meansan employee:
(1) who is employed to work at least thirty (30) hours eachweek. The term includes:
(A) a sole proprietor; and
(B) a partner in a partnership;
if the sole proprietor or partner is included as an employeeunder a health insurance plan of a small employer; and
(2) who meets an applicable waiting period required by a smallemployer before gaining coverage under a health insurancepolicy.
(b) The term does not include:
(1) an employee who works on a temporary or substitute basis;or
(2) a seasonal employee.
As added by P.L.93-1995, SEC.10.
IC 27-8-15-9
"Health insurance plan" defined
Sec. 9. (a) Except as provided in section 28 of this chapter, asused in this chapter, "health insurance plan" or "plan" means any:
(1) hospital or medical expense incurred policy or certificate;
(2) hospital or medical service plan contract; or
(3) health maintenance organization subscriber contract;
provided to the employees of a small employer.
(b) The term does not include the following:
(1) Accident-only, credit, dental, vision, Medicare supplement,long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy issued as an individual policy.
(6) A limited benefit health insurance policy issued as anindividual policy.
(7) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(8) A policy that provides a stipulated daily, weekly, or monthlypayment to an insured during hospital confinement, withoutregard to the actual expense of the confinement.
As added by P.L.127-1992, SEC.1. Amended by P.L.93-1995,SEC.11.
IC 27-8-15-10
"Insurer" defined
Sec. 10. As used in this chapter, "insurer" means any person whoprovides health insurance in Indiana. The term includes thefollowing:
(1) A licensed insurance company.
(2) A prepaid hospital or medical service plan.
(3) A health maintenance organization.
(4) A multiple employer welfare arrangement.
(5) Any person providing a plan of health insurance subject tostate insurance law.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-10.5
"Late enrollee" defined
Sec. 10.5. (a) As used in this chapter, "late enrollee" means aneligible employee or a dependent of an eligible employee who didnot request enrollment in a health insurance plan of a small employerduring the initial enrollment period during which the individual wasentitled to enroll under the health insurance plan.
(b) The term "late enrollee" does not include an eligible employeeor the dependent of an eligible employee:
(1) who was covered under a health insurance plan or hadhealth insurance coverage at the time coverage was previously
offered to the employee or to the dependent of the employee;
(2) who stated in writing at the time coverage was offered thatcoverage under another health insurance plan was the reason fordeclining the enrollment, but only if the insurer required sucha statement at the time and provided the employee with noticeof the requirement (and the consequences of the requirement)at the time;
(3) whose coverage under this subsection:
(A) was under a COBRA continuation provision and thecoverage under the provision was exhausted; or
(B) was not under a COBRA continuation provision andeither the coverage was terminated as a result of loss ofeligibility for the coverage (including as a result of legalseparation, divorce, death, termination of employment, orreduction in the number of hours of employment) oremployer contributions toward the coverage wereterminated; and
(4) who requests enrollment under the terms of the plan notlater than thirty (30) days after the date of exhaustion ofcoverage as described in subdivision (3)(A) or the terminationof coverage or employer contributions as described insubdivision (3)(B).
(c) The term "late enrollee" does not include an eligible employeewho is employed by a small employer that offers multiple healthinsurance plans and who elects a different plan during an openenrollment period.
(d) The term "late enrollee" does not include an eligible employeeor the eligible employee's spouse or minor or dependent child where:
(1) a court has ordered that health insurance coverage beprovided for the spouse or minor or dependent child of aneligible employee under the eligible employee's insurance plan;and
(2) the request for enrollment is made not more than thirty (30)days after the issuance of the court order.
As added by P.L.93-1995, SEC.12. Amended by P.L.190-1996,SEC.3; P.L.91-1998, SEC.15.
IC 27-8-15-11
"Midpoint rate" defined
Sec. 11. As used in this chapter, "midpoint rate" means for smallemployers with similar case and benefit design characteristics thearithmetic average of the applicable base premium rate and thecorresponding highest premium rate.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-12
"New business premium rate" defined
Sec. 12. As used in this chapter, "new business premium rate"means the premium rate charged or offered by the small employerinsurer to small employers with similar case characteristics and
benefit design characteristics for newly issued health insuranceplans.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-13
"Rating period" defined
Sec. 13. As used in this chapter, "rating period" means thecalendar period for which premium rates established by a smallemployer insurer are assumed to be in effect, as determined by thesmall employer insurer.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-14
"Small employer" defined
Sec. 14. As used in this chapter, "small employer" means anyperson, firm, corporation, limited liability company, partnership, orassociation actively engaged in business who, on at least fifty percent(50%) of the working days of the employer during the precedingcalendar year, employed at least two (2) but not more than fifty (50)eligible employees, the majority of whom work in Indiana. Indetermining the number of eligible employees, companies that areaffiliated companies or that are eligible to file a combined tax returnfor purposes of state taxation are considered one (1) employer.
As added by P.L.127-1992, SEC.1. Amended by P.L.8-1993,SEC.432; P.L.93-1995, SEC.13; P.L.190-1996, SEC.4; P.L.91-1998,SEC.16.
IC 27-8-15-15
"Small employer insurer" defined
Sec. 15. As used in this chapter, "small employer insurer" meansany insurer that offers a health insurance plan covering theemployees of a small employer.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-16
Premium rates
Sec. 16. Premium rates for a health insurance plan are subject tothe following:
(1) For all small employer business, the premium rates chargedduring a rating period to small employers with similar casecharacteristics for the same or similar benefit designcharacteristics, or the rates that could be charged to smallemployers under the rating system may not vary from themidpoint rate by more than thirty-five percent (35%) above orbelow the midpoint rate.
(2) The percentage increase in the premium rate charged to asmall employer for a new rating period may not exceed the sumof the following:
(A) The percentage change in the new business premium ratefor a plan with the same or similar benefit design
characteristics measured from the first day of the prior ratingperiod to the first day of the new rating period. For a plan forwhich the small employer insurer is not issuing new policies,the insurer shall use the percentage change in the basepremium rate.
(B) An adjustment, not to exceed fifteen percent (15%)annually and adjusted pro rata for rating periods of less thanone (1) year, due to the claim experience, health status, orduration of coverage of the employees or dependents of thesmall employer.
(C) Any adjustment due to change in benefit designcharacteristics or change in the case characteristics of thesmall employer.
(3) For health insurance plans issued before July 1, 1992, apremium rate for a rating period may exceed the rangesdescribed in subdivisions (1) and (2) for five (5) yearsfollowing July 1, 1992. The percentage increase in the premiumrate charged to a small employer in such a class of business fora new rating period may not exceed the sum of the following:
(A) The percentage change in the new business premium ratemeasured from the first day of the prior rating period to thefirst day of the new rating period. For a plan for which thesmall employer insurer is not issuing new policies, theinsurer shall use the percentage change in the base premiumrate.
(B) Any adjustment due to change in benefit designcharacteristics or change in the case characteristics of thesmall employer.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-17
Rating factors
Sec. 17. (a) This chapter is not intended to affect the use by asmall employer insurer of legitimate rating factors other than claimexperience, health status, or duration of coverage in thedetermination of premium rates.
(b) A small employer insurer shall apply rating factors, includingcase characteristics, consistently with respect to all small employersin a plan with substantially the same benefit design characteristics.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-18
Offer to transfer
Sec. 18. A small employer insurer may not offer to transfer asmall employer into or out of a plan with substantially the samebenefit design unless the offer is made to transfer all small employersin that plan without regard to case characteristics, claim experience,health status, or duration since issue.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-19
Cancellation or refusal of renewal of plans
Sec. 19. Except as provided in section 20 of this chapter, a smallemployer insurer may only cancel or refuse to renew a healthinsurance plan for the following reasons:
(1) Nonpayment of required premiums.
(2) Fraud or misrepresentation of the small employer, or withrespect to coverage of an insured individual, fraud ormisrepresentation by the insured individual or the individual'srepresentative.
(3) The small employer has failed to comply with a materialplan provision relating to employer contribution or groupparticipation rules.
(4) In the case of a small employer insurer that offers coveragein a market through a network plan, there is no longer anyinsured individual in connection with the plan who lives,resides, or works:
(A) in the service area of the small employer insurer; or
(B) in the area for which the issuer is authorized to dobusiness.
(5) In the case of coverage that is made available through one(1) or more bona fide associations, the membership of the smallemployer in the association ceases, but only if the coverage isterminated under this subdivision uniformly without regard toany health status related factor relating to an insured individual.
(6) In a case in which an insurer decides to discontinue offeringa particular type of group health insurance coverage offered inthe small employer market, that coverage may be discontinuedby the insurer only if:
(A) the insurer provides notice of the insurer's intent todiscontinue the coverage to each small employer providedwith the coverage;
(B) the insurer offers the option to purchase all other healthinsurance coverage currently being offered by the insurer tothe small employer to each small employer that is providedwith the coverage; and
(C) in exercising the option to discontinue the coverage inoffering the option of coverage under clause (B), the insureracts uniformly without regard to:
(i) the claims experience of the small employer groups; or
(ii) any health status related factor relating to any eligibleemployee or dependent of an eligible employee who iscovered or who may become eligible for the coverage.
As added by P.L.127-1992, SEC.1. Amended by P.L.93-1995,SEC.14; P.L.91-1998, SEC.17.
IC 27-8-15-20
Renewal cessation; notice
Sec. 20. (a) A small employer insurer may cease to renew allsmall employer plans. (b) The insurer shall provide notice to all affected healthinsurance plans and to the commissioner at least one (1) year beforetermination of coverage unless the coverage is placed with anotherinsurer.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-21
Renewal cessation; prohibitions
Sec. 21. (a) An insurer who ceases to renew all small employerplans may not do the following:
(1) Accept any new small employer business for five (5) yearsafter the notice of nonrenewal of the plans.
(2) Transfer or otherwise provide coverage to any of theemployers from the nonrenewed class of business unless theinsurer offers to transfer or provide coverage to all affectedemployers and eligible employees and dependents withoutregard to case characteristics, claim experience, health status,or duration of coverage.
(b) The commissioner may suspend the penalty under subsection(a)(1) upon a finding by the commissioner that the suspension wouldenhance the efficiency and fairness of the marketplace for smallemployer health insurance.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-22
Disclosure of premium rate changes
Sec. 22. Each small employer insurer shall make reasonabledisclosure in solicitation and sales materials provided to smallemployers of the provisions affecting premium rate changes.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-23
Maintenance of rating and renewal practice information anddocumentation
Sec. 23. Each small employer insurer shall maintain for three (3)years at the insurer's principal place of business a complete anddetailed description of the insurer's rating practices and renewalunderwriting practices, including information and documentation thatdemonstrate that the insurer's rating methods and practices are basedupon commonly accepted actuarial assumptions and are inaccordance with sound actuarial principles.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-24
Maintenance of actuarial certification; submission to department
Sec. 24. (a) Each small employer insurer shall maintain anactuarial certification verifying that the insurer is in compliance withthis chapter and that the rating methods of the insurer are actuariallysound. A copy of the certification shall be retained by the insurer atthe insurer's principal place of business for three (3) years. (b) Before March 1 of each year, each small employer insurershall submit to the department a copy of the actuarial certificationmaintained under subsection (a).
As added by P.L.127-1992, SEC.1. Amended by P.L.190-1996,SEC.5.
IC 27-8-15-25
Availability of information and documentation to commissioner;disclosure by commissioner
Sec. 25. A small employer insurer shall make the information anddocumentation described in section 23 of this chapter available to thecommissioner upon request. The information is proprietary and tradesecret information and is not subject to disclosure by thecommissioner to a person outside of the department except as agreedto by the insurer or as ordered by a court with jurisdiction.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-26
Suspension of premium rate provisions
Sec. 26. The commissioner may suspend all or any part of section16 of this chapter as to the premium rates applicable to one (1) smallemployer for at least one (1) rating period upon a filing by the smallemployer insurer and a finding by the commissioner that either:
(1) the suspension is reasonable in light of the financialcondition of the insurer; or
(2) the suspension would enhance the efficiency and fairness ofthe marketplace for small employer health insurance.
As added by P.L.127-1992, SEC.1.
IC 27-8-15-27
Compliance
Sec. 27. A health insurance plan provided by a small employerinsurer to a small employer must comply with the following:
(1) The benefits provided by a plan to an eligible employeeenrolled in the plan may not be excluded, limited, or denied formore than nine (9) months after the effective date of thecoverage because of a preexisting condition of the eligibleemployee, the eligible employee's spouse, or the eligibleemployee's dependent.
(2) The plan may not define a preexisting condition, rider, orendorsement more restrictively than as a condition for whichmedical advice, diagnosis, care, or treatment was recommendedor received during the six (6) months immediately preceding theeffective date of enrollment in the plan.
As added by P.L.93-1995, SEC.15. Amended by P.L.91-1998,SEC.18.
IC 27-8-15-28
Waiver of exclusion and limitation period
Sec. 28. (a) As used in this section, "health insurance plan" means
coverage provided under any of the following:
(1) A hospital or medical expense incurred policy or certificate.
(2) A hospital or medical service plan contract.
(3) A health maintenance organization subscriber contract.
(4) Medicare or Medicaid.
(5) An employer based health insurance arrangement.
(6) An individual health insurance policy.
(7) A policy issued by the Indiana comprehensive healthinsurance association under IC 27-8-10.
(8) An employee welfare benefit plan (as defined in 29 U.S.C.1002) that is self-funded.
(9) A conversion policy issued under section 31 or 31.1 of thischapter.
(b) Except as provided in section 29 of this chapter, a smallemployer insurer shall waive the exclusion period described insection 27 of this chapter applicable to a preexisting condition or thelimitation period with respect to a particular service in a healthinsurance plan for the time an eligible employee or a dependent of aneligible employee was previously covered by a health insurance planif the following conditions are met:
(1) The eligible employee or a dependent of the eligibleemployee was previously covered by a health insurance planthat provided benefits with respect to the particular service.
(2) Coverage under the health insurance plan was continuous toa date not more than sixty-three (63) days before the effectivedate of enrollment by:
(A) the eligible employee; or
(B) a dependent of the eligible employee.
(c) In determining whether an eligible employee or a dependentof the eligible employee meets the requirements of subsection (b)(2),a waiting period imposed by a small employer insurer or smallemployer before new coverage may become effective must beexcluded from the calculation.
(d) This section does not preclude the application of any waitingperiod applicable to all new enrollees under a plan.
As added by P.L.93-1995, SEC.16. Amended by P.L.190-1996,SEC.6; P.L.91-1998, SEC.19.
IC 27-8-15-29
Exclusion of coverage
Sec. 29. (a) A plan may exclude coverage for a late enrollee or thelate enrollee's covered spouse or dependent for not more than fifteen(15) months.
(b) If a late enrollee or the late enrollee's covered spouse ordependent has a preexisting condition, a plan may exclude coveragefor the preexisting condition for not more than fifteen (15) months.
(c) If a period of exclusion from coverage under subsection (a)and a preexisting condition exclusion under subsection (b) areapplicable to the late enrollee, the combined period of exclusion maynot exceed fifteen (15) months from the date that the eligible
employee enrolls for coverage under the health insurance plan.
As added by P.L.93-1995, SEC.17.
IC 27-8-15-30
Plan modifications prohibited
Sec. 30. Except as permitted under sections 27 and 29 of thischapter, a small employer insurer shall not modify a health insuranceplan with respect to:
(1) a small employer; or
(2) an eligible employee or dependent;
through riders, endorsements, or otherwise to restrict or excludecoverage or benefits for specific diseases, medical conditions, orservices otherwise covered by the plan.
As added by P.L.93-1995, SEC.18.
IC 27-8-15-31
Conversion
Sec. 31. (a) If an eligible employee who has been continuouslycovered under a health insurance plan for at least ninety (90) days:
(1) loses coverage under the plan as the result of:
(A) termination of employment;
(B) reduction of hours;
(C) marriage dissolution; or
(D) attainment of any age specified in the plan; and
(2) requests a conversion policy from the small employerinsurer that insured the health insurance plan;
the individual is entitled to receive a conversion policy from thesmall employer insurer.
(b) A request under subsection (a)(2) must be made within thirty(30) days after the individual loses coverage under the healthinsurance plan.
(c) The premium for a conversion policy issued under this sectionshall not exceed one hundred fifty percent (150%) of the rate thatwould have been charged under the small employer health insuranceplan with respect to the individual if the individual had been coveredas an eligible employee under the plan during the same period. If thehealth insurance plan under which the individual was covered iscanceled or is not renewed, the rates shall be based on the rate thatwould have been charged with respect to the individual if the planhad continued in force, as determined by the small employer insurerin accordance with standard actuarial principles.
(d) A conversion policy issued under this section must beapproved by the insurance commissioner as described in IC 27-8-5-1.The commissioner may not approve a conversion policy unless thepolicy and its benefits are:
(1) comparable to those required under IC 27-13-1-4(a)(2)through IC 27-13-1-4(a)(5);
(2) reasonable in relation to the premium charged; and
(3) in compliance with IC 27-8-6-1.
If the benefit limits of the conversion policy are not more than the
benefit limits of the small employer's health insurance plan, the smallemployer insurer shall credit the individual with any waiting period,deductible, or coinsurance credited to the individual under the smallemployer's health insurance plan.
(e) This section expires on the effective date of a mechanismenacted by the general assembly to offset the potential fiscal impacton small employers and small employer insurers that results from theestablishment of a continuation policy under section 31.1 of thischapter.
As added by P.L.93-1995, SEC.19.
IC 27-8-15-31.1
Continuing coverage
Sec. 31.1. (a) This section becomes effective on the effective dateof a mechanism enacted by the general assembly to offset thepotential fiscal impact on small employers and small employerinsurers that results from the establishment of a continuation policyunder this section. This section does not apply to an individual whois eligible for coverage under a group health plan (as defined in 29U.S.C. 1167).
(b) If an eligible employee who has been employed by the samesmall employer for at least one (1) year and continuously coveredunder a health insurance plan for at least ninety (90) days, or adependent of such eligible employee:
(1) loses coverage under the plan as the result of:
(A) termination of the eligible employee's employment;
(B) reduction of the eligible employee's hours;
(C) dissolution of marriage; or
(D) attainment of any age specified in the plan; and
(2) requests continuing coverage from the small employerinsurer that insured the health insurance plan;
the individual and any dependents of the individual are entitled toreceive continuing coverage from the small employer insurer.
(c) A small employer shall notify an individual of the individual'spossible right to continuing coverage under subsection (b) bypresenting notice to the individual in writing within ten (10) daysafter the individual becomes an eligible employee. The notice mustbe presented directly to the eligible employee and must include:
(1) the conditions under which the eligible employee mayqualify for continuing coverage;
(2) the name, address, and telephone number of the smallemployer insurer providing insurance to the small employer;and
(3) a statement that emphasizes the eligible employee'sresponsibility to contact the small employer insurer that insuresthe small employer at the time the eligible employee qualifiesfor continuing coverage under this section within thirty (30)days after becoming eligible for continuing coverage.
(d) An individual who wishes to receive continuing coverage mustrequest continuing coverage from the small employer insurer in
writing within thirty (30) days after losing coverage under subsection(b)(1).
(e) An individual electing continuing coverage must pay to theemployer, in advance of the date the employer is required to makepayments for insurance, but not more than one (1) time each month,the total premium amount required for continuing coverage.
(f) An individual who fails to:
(1) provide notice to a small employer insurer under subsection(d); or
(2) timely pay the premium as described in subsection (e);
relieves the employer and the small employer insurer of anyresponsibility to the individual for continuing coverage.
(g) A notification of the continuation privilege must accompanyor be included in each certificate of coverage.
(h) Continuing coverage shall not be available to an individualwho was discharged because the individual committed a felony ortheft in connection with the individual's work, provided that:
(1) the individual admits participating in the felony or theft;
(2) the discharge is upheld through binding arbitration; or
(3) the act resulted in a conviction or an order of or supervisionby a court.
(i) The premium for continuing coverage referred to in subsection(b) for any given period shall not exceed one hundred two percent(102%) of the rate that would have been charged under the healthinsurance plan with respect to the individual if the individual hadbeen covered as an eligible employee under the plan during the sameperiod. If the health insurance plan under which the individual wascovered is canceled or is not renewed, the individual may apply fora conversion policy under this section.
(j) Benefits provided under the continuing coverage referred to insubsection (b) may not be less than the benefits provided under thehealth insurance plan. If the plan limits of the continuing coverageare not greater than the plan limits of the health insurance plan, thesmall employer insurer shall credit the insured with any waitingperiod, deductible, and coinsurance to the extent that the waitingperiod, deductible, or coinsurance was credited to the individualunder the health insurance plan.
(k) Continuing coverage provided under this section may not lastlonger than twelve (12) months. If a small employer changes thehealth insurance plan during the time that continuing coverage isprovided to an individual under this section, the small employer shallnotify the individual in writing within thirty (30) days of the change,and the individual is entitled to apply for a conversion policy underthis section within thirty (30) days of receiving the notice.
(l) A small employer insurer who provides continuing coverageunder this section may not refuse to accept for coverage under aconversion policy any individual who remained continuously coveredunder this section if the individual can prove that:
(1) the individual is entitled to and has exhausted the benefitsavailable under continuing coverage or the health insurance
plan under which the individual was covered is canceled or isnot renewed under the provisions of section 19 of this chapter;
(2) the continuing coverage was continuous to a date not morethan thirty (30) days before the effective date of the coveragethe individual is applying for under this subsection; and
(3) the individual is not eligible for coverage under any otheremployer health insurance plan.
The premium for a conversion policy issued under this subsectionshall not exceed one hundred thirty-five percent (135%) of the ratethat would have been charged under the health insurance plan withrespect to the individual if the individual had been covered as aneligible employee under the plan during the same period. If the healthinsurance plan under which the individual was covered is canceledor is not renewed, the rate shall be based on the rate that would havebeen charged with respect to the individual if the plan had continuedin force, as determined by the small employer insurer in accordancewith standard actuarial principles.
As added by P.L.93-1995, SEC.20.
IC 27-8-15-32
Employees becoming eligible after employer's commencement ofhealth insurance plan entitled to coverage
Sec. 32. (a) If an individual:
(1) becomes an eligible employee of a small employer after thedate that a small employer insurer first insures an eligibleemployee of the small employer under a health insurance plan;and
(2) is not a late enrollee;
the individual and all dependents of the individual are entitled tocoverage under section 33 of this chapter, subject to the provisionsof sections 27 and 28 of this chapter.
As added by P.L.93-1995, SEC.21.
IC 27-8-15-33
Mandatory coverage by employer insurer to all employer's eligibleemployees and employees' dependents; employees decliningcoverage; minimum participation and contribution requirements
Sec. 33. (a) If a small employer insurer offers coverage under ahealth insurance plan to a small employer, the small employer insurershall provide the employer coverage under the plan for:
(1) all eligible employees of the small employer; and
(2) the dependents of all eligible employees of the smallemployer.
(b) Except as provided in section 29 of this chapter with respectto late enrollees, a small employer insurer shall not limit the insurer'sprovision of coverage to:
(1) certain individuals in a small employer group; or
(2) a part of a small employer group.
(c) This section does not prohibit an eligible employee fromdeclining coverage under this section. (d) Nothing in this chapter prohibits a small employer insurerfrom including minimum participation and contribution requirementsin its offer of coverage.
As added by P.L.93-1995, SEC.22.
IC 27-8-15-34
Repealed
(Repealed by P.L.91-1998, SEC.24.)
IC 27-8-15-34.1
All products required to be offered; all employers required to beaccepted
Sec. 34.1. Except as provided in 29 U.S.C. 1191a and 42 U.S.C.300gg, a small employer insurer must:
(1) offer to any small employer all products that are approvedfor sale in the small group market and that the insurer is activelymarketing; and
(2) accept any employer that applies for any of those products.
As added by P.L.91-1998, SEC.20.