A health benefit plan and a carrier offering such a plan shall permit an employee or a dependent of an employee covered by the health benefit plan who is eligible, but not enrolled, for coverage in connection with the health benefit plan to enroll for coverage under the terms of the health benefit plan if:

1.  The employee or dependent was covered under a different health benefit plan or had other health insurance coverage at the time coverage was previously offered to the employee or dependent;

2.  The employee stated in writing at that time that the other coverage was the reason for declining enrollment, but only if the plan sponsor or carrier required such a written statement and informed the employee of that requirement and the consequences of the requirement; and

3.  The employee or dependent:

(a) Was covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 relating to the continuation of coverage and such continuation of coverage was exhausted; or

(b) Was not covered under such a provision and his or her insurance coverage was lost as a result of cessation of contributions by his or her employer, termination of employment or eligibility, reduction in the number of hours of employment, or the death of, or divorce or legal separation from, a covered spouse.