044-49 Wyo. Code R. § 49-2

Current through April 27, 2019

Section 49-2 - Definitions

(a) For the purposes of this Regulation: "Associate member of an employee organization" means any individual who participates in an employee benefit plan (as defined in 29 U.S.C. § 1002(1) ) that is a multi-employer plan (as defined in 29 U.S.C. § 1002(37A) ), other than the following:

• (i) An individual, or the beneficiary of such individual, who is employed by a participating employer within a bargaining unit covered by at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained; or

• (ii) An individual who is a present or former employee, or a beneficiary of such employee, of the sponsoring employee organization, of an employer who is or was a party to at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained, or of the employee benefit plan or of a related plan.

(b) "New entrant" means an eligible employee, or the dependent of an eligible employee, if coverage is offered to the dependent, who becomes part of an employer group after the initial period for enrollment in a health benefit plan, and who enrolls on a timely basis within the prescribed enrollment period. If an eligible employee has continued coverage under the provisions of W. S. § 26-19-113, or under the provisions of applicable Federal law, and the continued coverage is voluntarily continued to, or is voluntarily terminated on, a date that is after the end of that person's prescribed initial enrollment period of a health benefit plan, that eligible employee and his or her dependents shall not be considered late enrollees, as defined in W.S. § 26-19-302(xv).

(c) "Qualifying previous coverage" and "qualifying existing coverage" means public or private benefits or coverage provided under:

• (i) Medicare, Medicaid, the Wyoming Health Insurance Pool, or other health benefit programs or coverages operated or maintained by any governmental entity;

• (ii) An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health plan; or

• (iii) An individual health benefit plan (including coverage issued by a health maintenance organization, prepaid hospital or medical care plan, or a fraternal benefit society) that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan.

(d) "Risk characteristic" means the claims experience, duration of coverage, or any similar characteristic related to the experience of a small employer group or of any member of a small employer group.

(e) "Risk load" means the percentage above the applicable base premium rate that is charged by a small employer carrier to a small employer to reflect the risk characteristics of the small employer group.

044-49 Wyo. Code R. § 49-2

Amended, Eff. 10/13/2015.