§ 38.2-3432.3. Limitation on preexisting condition exclusion period.
A. Subject to subsection B, a health insurer offering health insurancecoverage may, with respect to a participant or beneficiary, impose apreexisting limitation only if:
1. For group health insurance coverage, such exclusion relates to a condition(whether physical or mental), regardless of the cause of the condition, forwhich medical advice, diagnosis, care, or treatment was recommended orreceived within the six-month period ending on the enrollment date;
2. For individual health insurance coverage, such exclusion relates to acondition that, during a 12-month period immediately preceding the effectivedate of coverage, had manifested itself in such a manner as would cause anordinarily prudent person to seek diagnosis, care, or treatment, or for whichmedical advice, diagnosis, care or treatment was recommended or receivedwithin 12 months immediately preceding the effective date of coverage;
3. Such exclusion extends for a period of not more than 12 months (or 12months in the case of a late enrollee) after the enrollment date; and
4. The period of any such preexisting condition exclusion is reduced by theaggregate of the periods of creditable coverage, if any, applicable to theparticipant or beneficiary as of the enrollment date.
B. Exceptions:
1. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of an individual who, as of the last day of the 30-dayperiod beginning with the date of birth, is covered under creditable coverage;
2. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of a child who is adopted or placed for adoption beforeattaining 18 years of age and who, as of the last day of the 30-day periodbeginning on the date of the adoption or placement for adoption, is coveredunder creditable coverage. The previous sentence shall not apply to coveragebefore the date of such adoption or placement for adoption;
3. A health insurance issuer offering health insurance coverage may notimpose any preexisting condition exclusion relating to pregnancy as apreexisting condition, except in the case of individual health insurancecoverage for a person who is not considered an eligible individual, asdefined in § 38.2-3430.2, in which case the health insurance issuer mayimpose a preexisting condition exclusion for a pregnancy existing on theeffective date of coverage;
4. Subdivisions 1 and 2 of this subsection shall no longer apply to anindividual after the end of the first 63-day period during all of which theindividual was not covered under any creditable coverage; and
5. Subdivision A 4 of this section shall not apply to health insurancecoverage offered in the individual market on a "guarantee issue" basiswithout regard to health status including open enrollment policies orcontracts issued pursuant to § 38.2-4216.1 and policies, contracts,certificates or evidences of coverage issued through a bona fide associationor to students through school sponsored programs at a college or universityunless the person is an eligible individual as defined in § 38.2-3430.2.
C. A period of creditable coverage shall not be counted, with respect toenrollment of an individual under a health benefit plan, if, after suchperiod and before the enrollment date, there was a 63-day period during allof which the individual was not covered under any creditable coverage.
D. For purposes of subdivision B 4 and subsection C, any period that anindividual is in a waiting period for any coverage under a group health plan(or for group health insurance coverage) or is in an affiliation period shallnot be taken into account in determining the continuous period undersubsection C.
E. Methods of crediting coverage:
1. Except as otherwise provided under subdivision 2 of this subsection, ahealth insurance issuer offering group health coverage shall count a periodof creditable coverage without regard to the specific benefits covered duringthe period;
2. A health insurance issuer offering group health insurance coverage mayelect to count a period of creditable coverage based on coverage of benefitswithin each of several classes or categories of benefits rather than asprovided under subdivision 1 of this subsection. Such election shall be madeon a uniform basis for all participants and beneficiaries. Under suchelection a health insurance issuer shall count a period of creditablecoverage with respect to any class or category of benefits if any level ofbenefits is covered within such class or category;
3. In the case of an election with respect to a group plan under subdivision2 of this subsection (whether or not health insurance coverage is provided inconnection with such plan), the plan shall: (i) prominently state in anydisclosure statements concerning the plan, and state to each enrollee at thetime of enrollment under the plan, that the plan has made such election and(ii) include in such statements a description of the effect of this election;and
4. In the case of an election under subdivision 2 of this subsection withrespect to health insurance coverage offered by a health insurance issuer inthe small or large group market, the health insurance issuer shall: (i)prominently state in any disclosure statements concerning the coverage, andto each employer at the time of the offer or sale of the coverage, that thehealth insurance issuer has made such election and (ii) include in suchstatements a description of the effect of such election.
F. Periods of creditable coverage with respect to an individual shall beestablished through presentation of certifications described in subsection Gor in such other manner as may be specified in federal regulations.
G. A health insurance issuer offering group health insurance coverage shallprovide for certification of the period of creditable coverage:
1. At the time an individual ceases to be covered under the plan or otherwisebecomes covered under a COBRA continuation provision;
2. In the case of an individual becoming covered under a COBRA continuationprovision, at the time the individual ceases to be covered under suchprovision; and
3. At the request, or on behalf of, an individual made not later than 24months after the date of cessation of the coverage described in subdivision 1or 2 of this subsection, whichever is later. The certification undersubdivision 1 of this subsection may be provided, to the extent practicable,at a time consistent with notices required under any applicable COBRAcontinuation provision.
H. To the extent that medical care under a group health plan consists ofgroup health insurance coverage, the plan is deemed to have satisfied thecertification requirement under this section if the health insurance issueroffering the coverage provides for such certification in accordance with thissection.
I. In the case of an election described in subdivision E 2 by a healthinsurance issuer, if the health insurance issuer enrolls an individual forcoverage under the plan and the individual provides a certification ofcoverage of the individual under subsection F:
1. Upon request of such health insurance issuer, the entity which issued thecertification provided by the individual shall promptly disclose to suchrequesting group insurance issuer information on coverage of classes andcategories of health benefits available under such entity's plan or coverage;and
2. Such entity may charge the requesting health insurance issuer for thereasonable cost of disclosing such information.
J. A health insurance issuer offering group health insurance coverage shallpermit an employee who is eligible, but not enrolled, for coverage under theterms of the plan (or a dependent of such an employee if the dependent iseligible, but not enrolled, for coverage under such terms) to enroll forcoverage under the terms of the plan if each of the following conditions ismet:
1. The employee or dependent was covered under a group health plan or hadhealth insurance coverage at the time coverage was previously offered to theemployee or dependent;
2. The employee stated in writing at such time that coverage under a grouphealth plan or health insurance coverage was the reason for decliningenrollment, but only if the plan sponsor or health insurance issuer (ifapplicable) required such a statement at such time and provided the employeewith notice of such requirement (and the consequences of such requirement) atsuch time;
3. The employee's or dependent's coverage described in subdivision 1 of thissubsection: (i) was under a COBRA continuation provision and the coverageunder such provision was exhausted or (ii) was not under such a provision andeither the coverage was terminated as a result of loss of eligibility for thecoverage (including as a result of legal separation, divorce, death,termination of employment, or reduction in the number of hours of employment)or employer contributions towards such coverage were terminated; and
4. Under the terms of the plan, the employee requests such enrollment notlater than 30 days after the date of exhaustion of coverage described insubdivision 3 (i) of this subsection or termination of coverage or employercontribution described in subdivision 3 (ii) of this subsection.
K. If: (i) a health insurance issuer makes coverage available with respect toa dependent of an individual; (ii) the individual is a participant under theplan (or has met any waiting period applicable to becoming a participantunder the plan and is eligible to be enrolled under the plan but for afailure to enroll during a previous enrollment period); and (iii) a personbecomes such a dependent of the individual through marriage, birth, oradoption or placement for adoption, the health insurance issuer shall providefor a dependent special enrollment period described in subsection L of thissection during which the person (or, if not otherwise enrolled, theindividual) may also be enrolled under the plan as a dependent of theindividual, and in the case of the birth or adoption of a child, the spouseof the individual may also be enrolled as a dependent of the individual ifsuch spouse is otherwise eligible for coverage.
L. A dependent special enrollment period under this subsection shall be aperiod of not less than 30 days and shall begin on the later of:
1. The date dependent coverage is made available; or
2. The date of the marriage, birth, or adoption or placement for adoption (asthe case may be) described in subsection K.
M. If an individual seeks to enroll a dependent during the first 30 days ofsuch a dependent special enrollment period, the coverage of the dependentshall become effective:
1. In the case of marriage, not later than the first day of the first monthbeginning after the date the completed request for enrollment is received;
2. In the case of a dependent's birth, as of the date of such birth; or
3. In the case of a dependent's adoption or placement for adoption, the dateof such adoption or placement for adoption.
N. A late enrollee may be excluded from coverage for up to 12 months or mayhave a preexisting condition limitation apply for up to 12 months; however,in no case shall a late enrollee be excluded from some or all coverage formore than 12 months. An eligible employee or dependent shall not beconsidered a late enrollee if all of the conditions set forth below insubdivisions 1 through 4 are met or one of the conditions set forth below insubdivision 5 or 6 is met:
1. The individual was covered under a public or private health benefit planat the time the individual was eligible to enroll.
2. The individual certified at the time of initial enrollment that coverageunder another health benefit plan was the reason for declining enrollment.
3. The individual has lost coverage under a public or private health benefitplan as a result of termination of employment or employment statuseligibility, the termination of the other plan's entire group coverage, deathof a spouse, or divorce.
4. The individual requests enrollment within 30 days after termination ofcoverage provided under a public or private health benefit plan.
5. The individual is employed by a small employer that offers multiple healthbenefit plans and the individual elects a different plan offered by thatsmall employer during an open enrollment period.
6. A court has ordered that coverage be provided for a spouse or minor childunder a covered employee's health benefit plan, the minor is eligible forcoverage and is a dependent, and the request for enrollment is made within 30days after issuance of such court order.
However, such individual may be considered a late enrollee for benefit ridersor enhanced coverage levels not covered under the enrollee's prior plan.
(1997, cc. 807, 913; 1998, c. 24; 1999, c. 1004; 2000, c. 136; 2003, c. 221.)
§ 38.2-3432.3. Limitation on preexisting condition exclusion period.
A. Subject to subsection B, a health insurer offering health insurancecoverage may, with respect to a participant or beneficiary, impose apreexisting limitation only if:
1. For group health insurance coverage, such exclusion relates to a condition(whether physical or mental), regardless of the cause of the condition, forwhich medical advice, diagnosis, care, or treatment was recommended orreceived within the six-month period ending on the enrollment date;
2. For individual health insurance coverage, such exclusion relates to acondition that, during a 12-month period immediately preceding the effectivedate of coverage, had manifested itself in such a manner as would cause anordinarily prudent person to seek diagnosis, care, or treatment, or for whichmedical advice, diagnosis, care or treatment was recommended or receivedwithin 12 months immediately preceding the effective date of coverage;
3. Such exclusion extends for a period of not more than 12 months (or 12months in the case of a late enrollee) after the enrollment date; and
4. The period of any such preexisting condition exclusion is reduced by theaggregate of the periods of creditable coverage, if any, applicable to theparticipant or beneficiary as of the enrollment date.
B. Exceptions:
1. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of an individual who, as of the last day of the 30-dayperiod beginning with the date of birth, is covered under creditable coverage;
2. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of a child who is adopted or placed for adoption beforeattaining 18 years of age and who, as of the last day of the 30-day periodbeginning on the date of the adoption or placement for adoption, is coveredunder creditable coverage. The previous sentence shall not apply to coveragebefore the date of such adoption or placement for adoption;
3. A health insurance issuer offering health insurance coverage may notimpose any preexisting condition exclusion relating to pregnancy as apreexisting condition, except in the case of individual health insurancecoverage for a person who is not considered an eligible individual, asdefined in § 38.2-3430.2, in which case the health insurance issuer mayimpose a preexisting condition exclusion for a pregnancy existing on theeffective date of coverage;
4. Subdivisions 1 and 2 of this subsection shall no longer apply to anindividual after the end of the first 63-day period during all of which theindividual was not covered under any creditable coverage; and
5. Subdivision A 4 of this section shall not apply to health insurancecoverage offered in the individual market on a "guarantee issue" basiswithout regard to health status including open enrollment policies orcontracts issued pursuant to § 38.2-4216.1 and policies, contracts,certificates or evidences of coverage issued through a bona fide associationor to students through school sponsored programs at a college or universityunless the person is an eligible individual as defined in § 38.2-3430.2.
C. A period of creditable coverage shall not be counted, with respect toenrollment of an individual under a health benefit plan, if, after suchperiod and before the enrollment date, there was a 63-day period during allof which the individual was not covered under any creditable coverage.
D. For purposes of subdivision B 4 and subsection C, any period that anindividual is in a waiting period for any coverage under a group health plan(or for group health insurance coverage) or is in an affiliation period shallnot be taken into account in determining the continuous period undersubsection C.
E. Methods of crediting coverage:
1. Except as otherwise provided under subdivision 2 of this subsection, ahealth insurance issuer offering group health coverage shall count a periodof creditable coverage without regard to the specific benefits covered duringthe period;
2. A health insurance issuer offering group health insurance coverage mayelect to count a period of creditable coverage based on coverage of benefitswithin each of several classes or categories of benefits rather than asprovided under subdivision 1 of this subsection. Such election shall be madeon a uniform basis for all participants and beneficiaries. Under suchelection a health insurance issuer shall count a period of creditablecoverage with respect to any class or category of benefits if any level ofbenefits is covered within such class or category;
3. In the case of an election with respect to a group plan under subdivision2 of this subsection (whether or not health insurance coverage is provided inconnection with such plan), the plan shall: (i) prominently state in anydisclosure statements concerning the plan, and state to each enrollee at thetime of enrollment under the plan, that the plan has made such election and(ii) include in such statements a description of the effect of this election;and
4. In the case of an election under subdivision 2 of this subsection withrespect to health insurance coverage offered by a health insurance issuer inthe small or large group market, the health insurance issuer shall: (i)prominently state in any disclosure statements concerning the coverage, andto each employer at the time of the offer or sale of the coverage, that thehealth insurance issuer has made such election and (ii) include in suchstatements a description of the effect of such election.
F. Periods of creditable coverage with respect to an individual shall beestablished through presentation of certifications described in subsection Gor in such other manner as may be specified in federal regulations.
G. A health insurance issuer offering group health insurance coverage shallprovide for certification of the period of creditable coverage:
1. At the time an individual ceases to be covered under the plan or otherwisebecomes covered under a COBRA continuation provision;
2. In the case of an individual becoming covered under a COBRA continuationprovision, at the time the individual ceases to be covered under suchprovision; and
3. At the request, or on behalf of, an individual made not later than 24months after the date of cessation of the coverage described in subdivision 1or 2 of this subsection, whichever is later. The certification undersubdivision 1 of this subsection may be provided, to the extent practicable,at a time consistent with notices required under any applicable COBRAcontinuation provision.
H. To the extent that medical care under a group health plan consists ofgroup health insurance coverage, the plan is deemed to have satisfied thecertification requirement under this section if the health insurance issueroffering the coverage provides for such certification in accordance with thissection.
I. In the case of an election described in subdivision E 2 by a healthinsurance issuer, if the health insurance issuer enrolls an individual forcoverage under the plan and the individual provides a certification ofcoverage of the individual under subsection F:
1. Upon request of such health insurance issuer, the entity which issued thecertification provided by the individual shall promptly disclose to suchrequesting group insurance issuer information on coverage of classes andcategories of health benefits available under such entity's plan or coverage;and
2. Such entity may charge the requesting health insurance issuer for thereasonable cost of disclosing such information.
J. A health insurance issuer offering group health insurance coverage shallpermit an employee who is eligible, but not enrolled, for coverage under theterms of the plan (or a dependent of such an employee if the dependent iseligible, but not enrolled, for coverage under such terms) to enroll forcoverage under the terms of the plan if each of the following conditions ismet:
1. The employee or dependent was covered under a group health plan or hadhealth insurance coverage at the time coverage was previously offered to theemployee or dependent;
2. The employee stated in writing at such time that coverage under a grouphealth plan or health insurance coverage was the reason for decliningenrollment, but only if the plan sponsor or health insurance issuer (ifapplicable) required such a statement at such time and provided the employeewith notice of such requirement (and the consequences of such requirement) atsuch time;
3. The employee's or dependent's coverage described in subdivision 1 of thissubsection: (i) was under a COBRA continuation provision and the coverageunder such provision was exhausted or (ii) was not under such a provision andeither the coverage was terminated as a result of loss of eligibility for thecoverage (including as a result of legal separation, divorce, death,termination of employment, or reduction in the number of hours of employment)or employer contributions towards such coverage were terminated; and
4. Under the terms of the plan, the employee requests such enrollment notlater than 30 days after the date of exhaustion of coverage described insubdivision 3 (i) of this subsection or termination of coverage or employercontribution described in subdivision 3 (ii) of this subsection.
K. If: (i) a health insurance issuer makes coverage available with respect toa dependent of an individual; (ii) the individual is a participant under theplan (or has met any waiting period applicable to becoming a participantunder the plan and is eligible to be enrolled under the plan but for afailure to enroll during a previous enrollment period); and (iii) a personbecomes such a dependent of the individual through marriage, birth, oradoption or placement for adoption, the health insurance issuer shall providefor a dependent special enrollment period described in subsection L of thissection during which the person (or, if not otherwise enrolled, theindividual) may also be enrolled under the plan as a dependent of theindividual, and in the case of the birth or adoption of a child, the spouseof the individual may also be enrolled as a dependent of the individual ifsuch spouse is otherwise eligible for coverage.
L. A dependent special enrollment period under this subsection shall be aperiod of not less than 30 days and shall begin on the later of:
1. The date dependent coverage is made available; or
2. The date of the marriage, birth, or adoption or placement for adoption (asthe case may be) described in subsection K.
M. If an individual seeks to enroll a dependent during the first 30 days ofsuch a dependent special enrollment period, the coverage of the dependentshall become effective:
1. In the case of marriage, not later than the first day of the first monthbeginning after the date the completed request for enrollment is received;
2. In the case of a dependent's birth, as of the date of such birth; or
3. In the case of a dependent's adoption or placement for adoption, the dateof such adoption or placement for adoption.
N. A late enrollee may be excluded from coverage for up to 12 months or mayhave a preexisting condition limitation apply for up to 12 months; however,in no case shall a late enrollee be excluded from some or all coverage formore than 12 months. An eligible employee or dependent shall not beconsidered a late enrollee if all of the conditions set forth below insubdivisions 1 through 4 are met or one of the conditions set forth below insubdivision 5 or 6 is met:
1. The individual was covered under a public or private health benefit planat the time the individual was eligible to enroll.
2. The individual certified at the time of initial enrollment that coverageunder another health benefit plan was the reason for declining enrollment.
3. The individual has lost coverage under a public or private health benefitplan as a result of termination of employment or employment statuseligibility, the termination of the other plan's entire group coverage, deathof a spouse, or divorce.
4. The individual requests enrollment within 30 days after termination ofcoverage provided under a public or private health benefit plan.
5. The individual is employed by a small employer that offers multiple healthbenefit plans and the individual elects a different plan offered by thatsmall employer during an open enrollment period.
6. A court has ordered that coverage be provided for a spouse or minor childunder a covered employee's health benefit plan, the minor is eligible forcoverage and is a dependent, and the request for enrollment is made within 30days after issuance of such court order.
However, such individual may be considered a late enrollee for benefit ridersor enhanced coverage levels not covered under the enrollee's prior plan.
(1997, cc. 807, 913; 1998, c. 24; 1999, c. 1004; 2000, c. 136; 2003, c. 221.)
§ 38.2-3432.3. Limitation on preexisting condition exclusion period.
A. Subject to subsection B, a health insurer offering health insurancecoverage may, with respect to a participant or beneficiary, impose apreexisting limitation only if:
1. For group health insurance coverage, such exclusion relates to a condition(whether physical or mental), regardless of the cause of the condition, forwhich medical advice, diagnosis, care, or treatment was recommended orreceived within the six-month period ending on the enrollment date;
2. For individual health insurance coverage, such exclusion relates to acondition that, during a 12-month period immediately preceding the effectivedate of coverage, had manifested itself in such a manner as would cause anordinarily prudent person to seek diagnosis, care, or treatment, or for whichmedical advice, diagnosis, care or treatment was recommended or receivedwithin 12 months immediately preceding the effective date of coverage;
3. Such exclusion extends for a period of not more than 12 months (or 12months in the case of a late enrollee) after the enrollment date; and
4. The period of any such preexisting condition exclusion is reduced by theaggregate of the periods of creditable coverage, if any, applicable to theparticipant or beneficiary as of the enrollment date.
B. Exceptions:
1. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of an individual who, as of the last day of the 30-dayperiod beginning with the date of birth, is covered under creditable coverage;
2. Subject to subdivision 4 of this subsection, a health insurance issueroffering health insurance coverage may not impose any preexisting conditionexclusion in the case of a child who is adopted or placed for adoption beforeattaining 18 years of age and who, as of the last day of the 30-day periodbeginning on the date of the adoption or placement for adoption, is coveredunder creditable coverage. The previous sentence shall not apply to coveragebefore the date of such adoption or placement for adoption;
3. A health insurance issuer offering health insurance coverage may notimpose any preexisting condition exclusion relating to pregnancy as apreexisting condition, except in the case of individual health insurancecoverage for a person who is not considered an eligible individual, asdefined in § 38.2-3430.2, in which case the health insurance issuer mayimpose a preexisting condition exclusion for a pregnancy existing on theeffective date of coverage;
4. Subdivisions 1 and 2 of this subsection shall no longer apply to anindividual after the end of the first 63-day period during all of which theindividual was not covered under any creditable coverage; and
5. Subdivision A 4 of this section shall not apply to health insurancecoverage offered in the individual market on a "guarantee issue" basiswithout regard to health status including open enrollment policies orcontracts issued pursuant to § 38.2-4216.1 and policies, contracts,certificates or evidences of coverage issued through a bona fide associationor to students through school sponsored programs at a college or universityunless the person is an eligible individual as defined in § 38.2-3430.2.
C. A period of creditable coverage shall not be counted, with respect toenrollment of an individual under a health benefit plan, if, after suchperiod and before the enrollment date, there was a 63-day period during allof which the individual was not covered under any creditable coverage.
D. For purposes of subdivision B 4 and subsection C, any period that anindividual is in a waiting period for any coverage under a group health plan(or for group health insurance coverage) or is in an affiliation period shallnot be taken into account in determining the continuous period undersubsection C.
E. Methods of crediting coverage:
1. Except as otherwise provided under subdivision 2 of this subsection, ahealth insurance issuer offering group health coverage shall count a periodof creditable coverage without regard to the specific benefits covered duringthe period;
2. A health insurance issuer offering group health insurance coverage mayelect to count a period of creditable coverage based on coverage of benefitswithin each of several classes or categories of benefits rather than asprovided under subdivision 1 of this subsection. Such election shall be madeon a uniform basis for all participants and beneficiaries. Under suchelection a health insurance issuer shall count a period of creditablecoverage with respect to any class or category of benefits if any level ofbenefits is covered within such class or category;
3. In the case of an election with respect to a group plan under subdivision2 of this subsection (whether or not health insurance coverage is provided inconnection with such plan), the plan shall: (i) prominently state in anydisclosure statements concerning the plan, and state to each enrollee at thetime of enrollment under the plan, that the plan has made such election and(ii) include in such statements a description of the effect of this election;and
4. In the case of an election under subdivision 2 of this subsection withrespect to health insurance coverage offered by a health insurance issuer inthe small or large group market, the health insurance issuer shall: (i)prominently state in any disclosure statements concerning the coverage, andto each employer at the time of the offer or sale of the coverage, that thehealth insurance issuer has made such election and (ii) include in suchstatements a description of the effect of such election.
F. Periods of creditable coverage with respect to an individual shall beestablished through presentation of certifications described in subsection Gor in such other manner as may be specified in federal regulations.
G. A health insurance issuer offering group health insurance coverage shallprovide for certification of the period of creditable coverage:
1. At the time an individual ceases to be covered under the plan or otherwisebecomes covered under a COBRA continuation provision;
2. In the case of an individual becoming covered under a COBRA continuationprovision, at the time the individual ceases to be covered under suchprovision; and
3. At the request, or on behalf of, an individual made not later than 24months after the date of cessation of the coverage described in subdivision 1or 2 of this subsection, whichever is later. The certification undersubdivision 1 of this subsection may be provided, to the extent practicable,at a time consistent with notices required under any applicable COBRAcontinuation provision.
H. To the extent that medical care under a group health plan consists ofgroup health insurance coverage, the plan is deemed to have satisfied thecertification requirement under this section if the health insurance issueroffering the coverage provides for such certification in accordance with thissection.
I. In the case of an election described in subdivision E 2 by a healthinsurance issuer, if the health insurance issuer enrolls an individual forcoverage under the plan and the individual provides a certification ofcoverage of the individual under subsection F:
1. Upon request of such health insurance issuer, the entity which issued thecertification provided by the individual shall promptly disclose to suchrequesting group insurance issuer information on coverage of classes andcategories of health benefits available under such entity's plan or coverage;and
2. Such entity may charge the requesting health insurance issuer for thereasonable cost of disclosing such information.
J. A health insurance issuer offering group health insurance coverage shallpermit an employee who is eligible, but not enrolled, for coverage under theterms of the plan (or a dependent of such an employee if the dependent iseligible, but not enrolled, for coverage under such terms) to enroll forcoverage under the terms of the plan if each of the following conditions ismet:
1. The employee or dependent was covered under a group health plan or hadhealth insurance coverage at the time coverage was previously offered to theemployee or dependent;
2. The employee stated in writing at such time that coverage under a grouphealth plan or health insurance coverage was the reason for decliningenrollment, but only if the plan sponsor or health insurance issuer (ifapplicable) required such a statement at such time and provided the employeewith notice of such requirement (and the consequences of such requirement) atsuch time;
3. The employee's or dependent's coverage described in subdivision 1 of thissubsection: (i) was under a COBRA continuation provision and the coverageunder such provision was exhausted or (ii) was not under such a provision andeither the coverage was terminated as a result of loss of eligibility for thecoverage (including as a result of legal separation, divorce, death,termination of employment, or reduction in the number of hours of employment)or employer contributions towards such coverage were terminated; and
4. Under the terms of the plan, the employee requests such enrollment notlater than 30 days after the date of exhaustion of coverage described insubdivision 3 (i) of this subsection or termination of coverage or employercontribution described in subdivision 3 (ii) of this subsection.
K. If: (i) a health insurance issuer makes coverage available with respect toa dependent of an individual; (ii) the individual is a participant under theplan (or has met any waiting period applicable to becoming a participantunder the plan and is eligible to be enrolled under the plan but for afailure to enroll during a previous enrollment period); and (iii) a personbecomes such a dependent of the individual through marriage, birth, oradoption or placement for adoption, the health insurance issuer shall providefor a dependent special enrollment period described in subsection L of thissection during which the person (or, if not otherwise enrolled, theindividual) may also be enrolled under the plan as a dependent of theindividual, and in the case of the birth or adoption of a child, the spouseof the individual may also be enrolled as a dependent of the individual ifsuch spouse is otherwise eligible for coverage.
L. A dependent special enrollment period under this subsection shall be aperiod of not less than 30 days and shall begin on the later of:
1. The date dependent coverage is made available; or
2. The date of the marriage, birth, or adoption or placement for adoption (asthe case may be) described in subsection K.
M. If an individual seeks to enroll a dependent during the first 30 days ofsuch a dependent special enrollment period, the coverage of the dependentshall become effective:
1. In the case of marriage, not later than the first day of the first monthbeginning after the date the completed request for enrollment is received;
2. In the case of a dependent's birth, as of the date of such birth; or
3. In the case of a dependent's adoption or placement for adoption, the dateof such adoption or placement for adoption.
N. A late enrollee may be excluded from coverage for up to 12 months or mayhave a preexisting condition limitation apply for up to 12 months; however,in no case shall a late enrollee be excluded from some or all coverage formore than 12 months. An eligible employee or dependent shall not beconsidered a late enrollee if all of the conditions set forth below insubdivisions 1 through 4 are met or one of the conditions set forth below insubdivision 5 or 6 is met:
1. The individual was covered under a public or private health benefit planat the time the individual was eligible to enroll.
2. The individual certified at the time of initial enrollment that coverageunder another health benefit plan was the reason for declining enrollment.
3. The individual has lost coverage under a public or private health benefitplan as a result of termination of employment or employment statuseligibility, the termination of the other plan's entire group coverage, deathof a spouse, or divorce.
4. The individual requests enrollment within 30 days after termination ofcoverage provided under a public or private health benefit plan.
5. The individual is employed by a small employer that offers multiple healthbenefit plans and the individual elects a different plan offered by thatsmall employer during an open enrollment period.
6. A court has ordered that coverage be provided for a spouse or minor childunder a covered employee's health benefit plan, the minor is eligible forcoverage and is a dependent, and the request for enrollment is made within 30days after issuance of such court order.
However, such individual may be considered a late enrollee for benefit ridersor enhanced coverage levels not covered under the enrollee's prior plan.
(1997, cc. 807, 913; 1998, c. 24; 1999, c. 1004; 2000, c. 136; 2003, c. 221.)
