Section 45-06-12-03 - Special enrollments for certain individuals who losecoverage1. An insurer offering group health insurance coverage in connection with a group health benefit plan is required to permit employees and dependents described in this section to enroll for coverage under the terms of the plan if the conditions in subsection 4 are satisfied and the enrollment is requested within the period described in subsection 5. 2. An employee is described in this section if: a. The employee is eligible, but not enrolled, for coverage under the terms of the plan; and b. When enrollment was previously offered to the employee under the plan and was declined by the employee, the employee was covered under another group health benefit plan or had other health insurance coverage. 3. A dependent is described in this section if: a. The dependent is a dependent of an employee participating in the plan; b. The dependent is eligible, but not enrolled, for coverage under the terms of the plan; and c. When enrollment was previously offered under the plan and was declined, the dependent was covered under another group health benefit plan or had other health insurance coverage. 4. An employee or dependent described above is eligible to enroll during a special enrollment period if each of the following applicable conditions is met: a. When the employee declined enrollment for the employee or the dependent, the employee stated in writing that coverage under another group health benefit plan or other health insurance coverage was the reason for declining enrollment. This paragraph only applies if: (1) The plan required such a statement when the employee declined enrollment; and (2) The employee is provided with notice of the requirement to provide the statement in this section, and the consequences of the employee's failure to provide the statement, at the time the employee declined enrollment. b.(1) When the employee declined enrollment for the employee or dependent under the plan, the employee or dependent had Consolidated Omnibus Budget Reconciliation Act [ Pub. L. 99-272; 100 Stat. 82] continuation coverage under another plan and Consolidated Omnibus Budget Reconciliation Act continuation coverage under the other plan has since been exhausted; or (2) If the other coverage that applied to the employee or dependent when enrollment was declined was not under a Consolidated Omnibus Budget Reconciliation Act continuation provision, either the other coverage has been terminated as a result of loss of eligibility for the coverage or employer contributions towards the other coverage has been terminated. For this purpose, loss of eligibility for coverage includes a loss of coverage as a result of legal separation, divorce, death, termination of employment, reduction of the number of hours of employment and any loss of eligibility after a period that is measured by reference to any of the foregoing. 5. The employee is required to request enrollment for the employee or the employee's dependent not later than thirty days after the exhaustion of the other coverage described in this section or termination of other coverage has resulted in the loss of eligibility for the other coverage for items described in this section or following the termination of employer contributions toward the other coverage. The plan may impose the same requirements that apply to employees who are otherwise eligible under the plan to immediately request enrollment for coverage. 6. Enrollment is effective not later than the first day of the first calendar month beginning after the date the completed request is received. N.D. Admin Code 45-06-12-03
Effective December 1, 1997.General Authority: NDCC 28-32-02(1)
Law Implemented: NDCC 26.1-36.4