230 R.I. Code R. 230-RICR-20-30-10.6

Current through December 3, 2024
Section 230-RICR-20-30-10.6 - Requirement to Insure Entire Group
A. Coverage for each eligible employee and dependent. A small employer carrier that offers coverage to a small employer shall offer to provide coverage to each eligible employee and to each dependent of an eligible employee. Except as provided in § 10.6(B) of this Part, the small employer carrier shall provide the same health benefit plan to each such employee and dependent.
B. Offering one or more health benefit plans. A small employer carrier may offer the employees of a small employer the option of choosing one or more health benefit plans, provided that each employee may choose any of the offered plans. Except as provided in R.I. Gen. Laws § 27-50-7(d) (with respect to exclusions for preexisting conditions), the choice among benefit plans may not be limited, restricted or conditioned based upon the risk characteristics or a health status-related factor of the employees or their dependents.
C. List of eligible employees and dependents. A small employer carrier shall require each small employer that initially applies for coverage, as part of the application process, to provide a complete list of eligible employees and dependents of eligible employees as defined in R.I. Gen. Laws § 27-50-3(m). The small employer carrier shall require the small employer to provide appropriate supporting documentation (such as the W-2 Summary Wage and Tax Form) to verify the information required hereunder. Thereafter, eligibility documentation shall only be required for new employees and/or dependents who apply for coverage. Complete recertification of all eligible employees and dependents, or recertification of a particular employee and/or dependent may be required by the carrier at any time.
D. Waivers.
1. A small employer carrier shall obtain a waiver from each eligible employee and each dependent of such an eligible employee who declines an offer of coverage under a health benefit plan provided to a small employer.
2. The waiver shall be signed by the eligible employee (on behalf of such employee or the dependent of such employee) and shall certify that the individual who declined coverage was informed of the availability of coverage under the health benefit plan.
3. The waiver form shall:
a. require that the reason for declining coverage be stated on the form;
b. include a written warning of the penalties imposed on late enrollees;
c. include a statement informing the eligible employee of their special enrollment rights, if any, under R.I. Gen. Laws § 27-50-7(d)(7) or (8); and
d. include the model description of special enrollment rights contained in Appendix A issued in a bulletin promulgated for that purpose, or a substantially similar description.
4. In the event that an eligible employee or dependent refuses to sign the waiver required hereunder, the small employer must certify such refusal in writing.
5. Waivers and certifications of refusal to sign waivers shall be maintained by the small employer carrier for a period of six years.
E. Refusal to provide the list of eligible employees and dependents. A small employer carrier shall not issue coverage (either new coverage or renewal coverage) to a small employer that refuses to provide the list of eligible employees and dependents pursuant to § 10.6(C) of this Part or a waiver required under § 10.6(D) of this Part. If a small employer fails to supply adequate supporting documentation, the carrier is required to presume that the employer is not eligible for issuance or renewal of coverage as a small employer. Individuals whose small employer benefits are declined or non-renewed shall be offered conversion, continuation or individual coverage as required under other applicable laws and regulations.
F. Extended medical leave. Small employer carriers must provide coverage for employees of a small employer on extended medical leave consistent with the requirements of R.I. Gen. Laws Chapter 27-18.7.

230 R.I. Code R. 230-RICR-20-30-10.6