6.6.5079 OPPORTUNITIES FOR INDIVIDUALS TO ENROLL IN SMALL GROUP PLANS
(1) Upon the inception of a small group health plan all eligible employees and
their dependents, and thereafter all new eligible employees and their
dependents, must be offered an opportunity to enroll in the plan. Any waiting
period prior to enrollment may not exceed twelve months. If a small employer
carrier issues more than one health benefit plan to a small employer group
pursuant to ARM 6.6.5058(2) , all eligible employees must be offered the same
choice of health benefit plans as the other members of the group.
(2) Except as provided in (3) , eligible employees who do not enroll during an
initial enrollment opportunity as described in (1) , provided that the opportunity
lasted at least 30 days, may be considered late enrollees. A carrier may not
impose a preexisting condition exclusion of more than 18 months from the date
of a late enrollee's application. Although 33-22-1811(3) (c) , MCA, allows
a carrier to impose an 18 month period of exclusion from coverage or an 18
month preexisting condition exclusion for late enrollees, the federal Health
Insurance Portability and Accountability Act of 1996 does not allow both and
only authorizes a maximum 18 month preexisting condition exclusion. Therefore,
late enrollees may only be subject to the 18 month preexisting condition
exclusion from the date of application and a carrier must not impose
unreasonable delays in issuing coverage from the date of such application.
individuals who meet the requirements set forth in 33-22-140(17) (a) ,
(b) or (c) which provides exceptions to late enrollee status, or who qualify
for a special enrollment period under 33-22-523, MCA, are not
considered late enrollees. Individuals qualifying for special enrollment must
be given an opportunity to enroll according to the terms of 33-22-523,
MCA. Eligible individuals who are not late enrollees under the terms of 33-22-140(17) (a) ,
(b) or (c) , MCA, must be given opportunities to enroll as set forth in (1) , and
the enrollment period must extend at least 30 days.
or before the time an employee is offered an initial opportunity to enroll in a
group health plan, the plan is required to provide the employee with a
description, as set forth in ARM 6.6.50791(3) of the plan's special enrollment
rules. Additionally, the plan shall provide at the same time a description of
opportunities to enroll under 33-22-140(17) (a) , (b) or (c) , MCA,
and as a late enrollee.
History: Sec. 33-22-143 and 33-22-1822, MCA; IMP, Sec. 33-22-140, 33-22-523, 33-22-526, and 33-22-1811, MCA; NEW, 1998 MAR p. 1698, Eff. 6/26/98.