Ala. Admin. Code r. 482-1-116-.03

Current through Register Vol. 43, No. 1, October 31, 2024

Section 482-1-116-.03 - Applicability And Scope

(a) This Regulation shall apply to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met:

(1) Any portion of the premium or benefits is paid by or on behalf of the small employer.

(2) An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium.

(3) The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of Section 162, Section 125 or Section 106 of the United States Internal Revenue Code.

(4) The health benefit plan is marketed to individual employees through an employer.

(b)

(1) Except as provided in Subdivision (2), for the purposes of this Regulation, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this Regulation shall apply as if all health benefit plans delivered or issued for delivery to small employers in this state by such affiliated carriers were issued by one carrier.

(2) An affiliated carrier that is a health maintenance organization having a certificate of authority under Section 27-21A-1, etseq., Code of Ala. 1975, may be considered to be a separate carrier for the purposes of this Regulation.

Author: Reyn Norman, Associate Counsel

Ala. Admin. Code r. 482-1-116-.03

New Rule: September 3, 1997; effective September 28, 1997. Amended: October 14, 1999; effective January 1, 2000. Amended: September 12, 2001; effective October 1, 2001. Filed with LRS September 14, 2001. Rule is not subject to the Alabama Administrative Procedure Act.

Statutory Authority:Code of Ala. 1975, § 27-52-21.