SECTION 365:10-5-156. Requirement to insure entire groups

(a)   Offer and option requirements.

(1)   A small employer carrier that offers coverage to a small employer shall offer to provide coverage to each eligible employee and to each dependent of an eligible employee. Except as provided in Paragraph (2), the small employer carrier shall provide the same health benefit plan to each such employee and dependent.

(2)   A small employer carrier may offer the employees of a small employer the option of choosing among one or more health benefit plans, provided that each employee may choose any of the offered plans. Except as provided in 36 O.S.Supp.1994, §6519(C) (exclusions for preexisting conditions), the choice among benefit plans may not be limited, restricted or conditioned based upon the risk characteristics of the employees or their dependents.

(b)   Employee list requirement.

(1)   A small employer carrier shall require each small employer that applies for coverage, as part of the application process, to provide a complete list of eligible employees and dependents of eligible employees as defined in 36 O.S.Supp.1994, §6512(14) & (15). The small employer carrier shall require the small employer to provide appropriate supporting documentation (such as the W-2 Summary Wage and Tax Form) to verify the information required under 365:10-5-156(b)(1).

(2)   A small employer carrier shall secure a waiver with respect to each eligible employee and each dependent of such an eligible employee who declines an offer of coverage under a health benefit plan provided to a small employer. The waiver shall be signed by the eligible employee (on behalf of such employee or the dependent of such employee) and shall certify that the individual who declined coverage was informed of the availability of coverage under the health benefit plan. The waiver form shall require that the reason for declining coverage be stated on the form and shall include a written warning of the penalties imposed on late enrolees. Waivers shall be maintained by the small employer carrier for a period of six (6) years.

(3)   A small employer carrier shall not issue coverage to a small employer that refuses to provide the list required under 365:10-5-156(b)(1) or a waiver required under 365:10-5-156(b)(2).

(4)   Inducement or pressure prohibited.

(A)   A small employer carrier shall not issue coverage to a small employer if the carrier, or a producer for such carrier, has reason to believe that the small employer has induced or pressured an eligible employee or dependent of an eligible employee to decline coverage due to the individual's risk characteristics.

(B)   A producer shall notify a small employer carrier, prior to submitting an application for coverage with the carrier on behalf of a small employer, of any circumstances that would indicate that the small employer has induced or pressured an eligible employee or dependent of an eligible employee to decline coverage due to the individual's risk characteristics.

[Source: Added at 12 Ok Reg 3137, eff 7-31-95]