(a) This Regulation shall apply to any health benefit plan, whether provided on a group or individual basis, which: - (i) Meets one or more of the conditions set forth in W.S. § 26-19-303;
- (ii) Provides coverage to two or more eligible employees of a small employer, without regard to whether the policy or certificate was issued in this state; and
- (iii) Is in effect on or after the effective date of W.S. § 26-19-301 et seq.
(b) A carrier that provides an individual health benefit plan to two or more of the employees of a small employer shall be considered a small employer carrier and shall be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation with respect to such policies if the small employer contributes directly or indirectly to the premiums for the policies and the carrier is aware or should have been aware of such contribution as is explained in W.S. § 26-19-303.
(c) In the case of a carrier that provides individual health benefit plans to two or more employees of a small employer, the small employer shall be considered to be an eligible small employer as defined in W.S. § 26-19-302(a)(xxii) and the small employer carrier shall be subject to W.S. § 26 - 19 - 306(a) (relating to guaranteed issue of coverage) if: - (i) The small employer has at least two (2) employees;
- (ii) The small employer contributes directly or indirectly to the premiums charged by the carrier; and
- (iii) The carrier is aware or should have been aware of the contribution by the employer.
(d) The provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan provided to a small employer or to the employees of a small employer without regard to whether the health benefit plan is offered under or provided through a group policy or trust arrangement of any size sponsored by an association or discretionary group.
(e) An individual health insurance policy shall not be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation solely because the policyholder elects a deduction under Section 162(l) of the Internal Revenue Code.
(f) Change in Employer Status: - (i) If a small employer, as defined by applicable federal or state law, is issued a health benefit plan under the terms of W.S. § 26-19-301 et seq., the provisions of W.S. § 26-19-301 et seq. and this Regulation shall continue to apply to the health benefit plan in the case that the small employer subsequently employs more than the required number of eligible employees to be considered a small employer. A carrier providing coverage to such an employer shall, within sixty (60) days of becoming aware that the employer has more than the required number of eligible employees to be considered a small employer but no later than the anniversary date of the employer's health benefit plan, notify the employer that the protection provided under W.S. § 26-19-301 et seq. and this Regulation shall cease to apply to the employer if such employer fails to renew its current health benefit plan or elects to enroll in a different health benefit plan.
- (ii) If a health benefit plan is issued to an employer that is not a small employer as defined in W.S. § 26-19-302(a)(xxii) or as defined by applicable federal or state law, but subsequently the employer becomes a small employer (due to the loss or change of work status of one or more eligible employees), the terms of W.S. § 26-19-301 et seq. shall not apply to the health benefit plan. The carrier providing a health benefit plan to such an employer shall not become a small employer carrier under the terms of W.S. § 26-19-301 et seq. solely because the carrier continues to provide coverage under the health benefit plan to the employer
- (iii) A carrier providing coverage to an employer described in subparagraph (f)(ii) , who becomes aware that the employer meets the requirements to be a small employer, as defined by applicable federal or state law, shall notify the employer within sixty (60) days of the options and protections available to the employer under W.S. § 26-19-301 et seq., including the employer's option to purchase a small employer health benefit plan from any small employer carrier.
- (iv) If a small employer has employees in more than one state, the provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan issued to the small employer if:
- (A) The majority of eligible employees of such small employer are employed in this state, or are residents of Wyoming; or
- (B) If no state contains a majority of the eligible employees of the small employer, the primary business location for plan determination of the small employer shall be Wyoming.
- (v) In determining whether the laws of Wyoming or another state apply to a health benefit plan issued to a small employer, the provisions of subparagraph (iv) shall be applied as of the plan issuance date.
- (vi) If a health benefit plan is subject to W.S. § 26-19-301 et seq. and this Regulation, these provisions shall apply to all individuals covered under the health benefit plan, whether they reside in Wyoming or in another state.
(g) A carrier that is not operating as a small employer carrier in Wyoming shall not become subject to these provisions solely because a small employer that was issued a health benefit plan in another state by that carrier moves to Wyoming.
044-49 Wyo. Code R. § 49-3
Amended, Eff. 10/13/2015.