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H.B. 91
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VETOES
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[(3)] (4) who has not had the most recent prior creditable coverage
described in paragraph (l)(ii) of this subsection terminated for nonpayment of
premiums or fraud by the individual; and
[(4)] (5) who, if the individual has been offered the option of
continuation coverage under a State or federal continuation provision:
(i) has elected that coverage; and
(ii) has exhausted that coverage.
15-1401.
(p) "Special enrollment period" means a period during which a group health
plan shall permit [an employee] CERTAIN INDIVIDUALS who [is] ARE eligible for
coverage, but not enrolled, to enroll for coverage under the terms of the group health
benefit plan.
15-1406.
(a) A carrier may not establish rules for eligibility of an individual to enroll
under a group health [benefits] BENEFIT plan based on any health status-related
factor.
(b) Subsection (a) of this section does not:
(1) require a carrier to provide particular benefits other than those
provided under the terms of the particular health benefit plan; or
(2) prevent a carrier from establishing limitations or restrictions on the
amount, level, extent, or nature of the benefits or coverage for similarly situated
individuals enrolled in the health benefit plan.
(c) Rules for eligibility to enroll under a plan includes rules defining any
applicable waiting periods for enrollment.
(d) A carrier shall allow an employee or dependent who is eligible, but not
enrolled, for coverage under the terms of a group health [benefits] BENEFIT plan to
enroll for coverage under the terms of the plan if:
(1) the employee or dependent was covered under an
employer-sponsored plan or group health [benefits] BENEFIT plan at the time
coverage was previously offered to the employee or dependent;
(2) the employee states in writing, at the time coverage was previously
offered, that coverage under an employer—sponsored plan or group health [benefits]
BENEFIT plan was the reason for declining enrollment, but only if the plan sponsor or
issuer requires the statement and provides the employee with notice of the
requirement; and
(3) the employee's or dependent's coverage described in item (1) of this
subsection:
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- 4260 -
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