044-49 Wyo. Code R. § 49-12

Current through April 27, 2019

Section 49-12 - Rules Related to Fair Marketing

(a) A small employer carrier shall actively market each of its health benefit plans in Wyoming. A small employer carrier may not suspend the marketing or issuance of the basic and standard health benefit plans unless the carrier has good cause and has received the prior approval of the Commissioner.

(b) In marketing the basic and standard health benefit plans, a small employer carrier shall use at least the same sources and methods of distribution that it uses to market other health benefit plans. Any producer authorized by a small employer carrier to market health benefit plans in Wyoming shall also be authorized to market the basic and standard health benefit plans.

(c) A small employer carrier shall actively offer all health benefit plans actively marketed in Wyoming to any small employer that applies for or makes an inquiry regarding health insurance coverage. The offer shall be in writing and the offer may be provided directly to the small employer or delivered through a producer and shall include at least the following information:

(i) A general description of the benefits contained in the basic and standard healthbenefit plans and any other health benefit plan being offered to the small employer; and

(ii) Information describing how the small employer may enroll in the plans.

(d) A small employer carrier shall provide a price quote to a small employer directly or through an authorized producer within fifteen (15) working days of receiving a request for a quote and such information as is necessary to provide the quote. A small employer carrier shall notify a small employer directly or through an authorized producer within ten (10) working days of receiving a request for a price quote of any additional information needed to provide the quote.

(e) A small employer carrier may not apply more stringent or detailed requirements related to the application process for the basic and standard health benefit plans than are applied for other health benefit plans.

(f) The small group carrier shall not require a small employer to join or contribute to any association or group as a condition of being accepted for coverage, unless, membership in an association or other group is a requirement for accepting a small employer into a particular health benefit plan.

(g) A small employer carrier shall not require, as a condition to the offer or sale of a health benefit plan to a small employer, that the small employer purchase or qualify for any other insurance product or service.

(h) Carriers offering individual and group health benefit plans in Wyoming shall be responsible for determining whether the plans are subject to the requirements of W.S. § 26-19-301 et seq. and this Regulation. Carriers shall elicit the following information from applicants for such plans at the time of application:

(i) Whether or not any portion of the premium will be paid by or on behalf of a small employer, either directly or through wage adjustments or other means of reimbursement; and

(ii) Whether or not the prospective policyholder, certificate holder or any prospective insured individual intends to treat the health benefit plan as part of a plan or program under Section 162 (other than Section 162(l) ), Section 125 or Section 106 of the United States Internal Revenue Code.

(i) If a small employer carrier fails to comply with subparagraph (h), the small employer carrier shall be deemed to be on notice of any information that could reasonably have been attained if the small employer carrier had complied with subparagraph (h).

(j) A small employer carrier shall file annually on or before March 15, in a format prescribed by the Commissioner, the following information related to health benefit plans issued by the small employer carrier to small employers in Wyoming:

(i) The number of small employers that were issued health benefit plans in the previous calendar year, separated as to newly issued plans and renewals;

(ii) The number of small employers that were issued the basic health benefit plan and the standard health benefit plan in the previous calendar year, separated as to newly issued plans and renewals;

(iii) The number of small employer health benefit plans in force in each county, or by zip code, of the state as of December 31 of the previous calendar year;

(iv) The number of small employer health benefit plans that were voluntarily not renewed by small employers in the previous calendar year;

(v) The number of small employer health benefit plans that were terminated or non-renewed for reasons other than nonpayment of premium by the carrier in the previous calendar year; and

(vi) The number of small employer health benefit plans that were issued to small employers that were uninsured for at least the three (3) months prior to issue.

044-49 Wyo. Code R. § 49-12

Amended, Eff. 10/13/2015.