Sec. 31.1. (a) This section becomes effective on the effective date of a mechanism enacted by the general assembly to offset the potential fiscal impact on small employers and small employer insurers that results from the establishment of a continuation policy under this section. This section does not apply to an individual who is eligible for coverage under a group health plan (as defined in 29 U.S.C. § 1167).

     (b) If an eligible employee who has been employed by the same small employer for at least one (1) year and continuously covered under a health insurance plan for at least ninety (90) days, or a dependent of such eligible employee:

(1) loses coverage under the plan as the result of:

(A) termination of the eligible employee’s employment;

(B) reduction of the eligible employee’s hours;

(C) dissolution of marriage; or

(D) attainment of any age specified in the plan; and

(2) requests continuing coverage from the small employer insurer that insured the health insurance plan;

the individual and any dependents of the individual are entitled to receive continuing coverage from the small employer insurer.

     (c) A small employer shall notify an individual of the individual’s possible right to continuing coverage under subsection (b) by presenting notice to the individual in writing within ten (10) days after the individual becomes an eligible employee. The notice must be presented directly to the eligible employee and must include:

(1) the conditions under which the eligible employee may qualify for continuing coverage;

(2) the name, address, and telephone number of the small employer insurer providing insurance to the small employer; and

(3) a statement that emphasizes the eligible employee’s responsibility to contact the small employer insurer that insures the small employer at the time the eligible employee qualifies for continuing coverage under this section within thirty (30) days after becoming eligible for continuing coverage.

     (d) An individual who wishes to receive continuing coverage must request continuing coverage from the small employer insurer in writing within thirty (30) days after losing coverage under subsection (b)(1).

     (e) An individual electing continuing coverage must pay to the employer, in advance of the date the employer is required to make payments for insurance, but not more than one (1) time each month, the total premium amount required for continuing coverage.

     (f) An individual who fails to:

(1) provide notice to a small employer insurer under subsection (d); or

(2) timely pay the premium as described in subsection (e);

relieves the employer and the small employer insurer of any responsibility to the individual for continuing coverage.

     (g) A notification of the continuation privilege must accompany or be included in each certificate of coverage.

     (h) Continuing coverage shall not be available to an individual who was discharged because the individual committed a felony or theft in connection with the individual’s work, provided that:

(1) the individual admits participating in the felony or theft;

(2) the discharge is upheld through binding arbitration; or

(3) the act resulted in a conviction or an order of or supervision by a court.

     (i) The premium for continuing coverage referred to in subsection (b) for any given period shall not exceed one hundred two percent (102%) of the rate that would have been charged under the health insurance plan with respect to the individual if the individual had been covered as an eligible employee under the plan during the same period. If the health insurance plan under which the individual was covered is canceled or is not renewed, the individual may apply for a conversion policy under this section.

     (j) Benefits provided under the continuing coverage referred to in subsection (b) may not be less than the benefits provided under the health insurance plan. If the plan limits of the continuing coverage are not greater than the plan limits of the health insurance plan, the small employer insurer shall credit the insured with any waiting period, deductible, and coinsurance to the extent that the waiting period, deductible, or coinsurance was credited to the individual under the health insurance plan.

     (k) Continuing coverage provided under this section may not last longer than twelve (12) months. If a small employer changes the health insurance plan during the time that continuing coverage is provided to an individual under this section, the small employer shall notify the individual in writing within thirty (30) days of the change, and the individual is entitled to apply for a conversion policy under this section within thirty (30) days of receiving the notice.

     (l) A small employer insurer who provides continuing coverage under this section may not refuse to accept for coverage under a conversion policy any individual who remained continuously covered under this section if the individual can prove that:

(1) the individual is entitled to and has exhausted the benefits available under continuing coverage or the health insurance plan under which the individual was covered is canceled or is not renewed under the provisions of section 19 of this chapter;

(2) the continuing coverage was continuous to a date not more than thirty (30) days before the effective date of the coverage the individual is applying for under this subsection; and

(3) the individual is not eligible for coverage under any other employer health insurance plan.

The premium for a conversion policy issued under this subsection shall not exceed one hundred thirty-five percent (135%) of the rate that would have been charged under the health insurance plan with respect to the individual if the individual had been covered as an eligible employee under the plan during the same period. If the health insurance plan under which the individual was covered is canceled or is not renewed, the rate shall be based on the rate that would have been charged with respect to the individual if the plan had continued in force, as determined by the small employer insurer in accordance with standard actuarial principles.

As added by P.L.93-1995, SEC.20.