§ 27-18.6-6 - Applicability – Exclusion of certain plans.
SECTION 27-18.6-6
§ 27-18.6-6 Applicability – Exclusionof certain plans. – (a) The requirements of this chapter do not apply to any group health plan (andhealth insurance coverage offered in connection with a group health plan) forany plan year if, on the first day of the plan year, the plan does not meet thedefinition of large employer and is subject to the provisions of chapter 50 ofthis title.
(b) The requirements of this chapter apply with respect togroup health plans only:
(i) In the case of a plan that is a nonfederal governmentalplan; and
(ii) With respect to group health insurance coverage offeredin connection with a group health plan (including a plan that is a church planor a governmental plan).
(2) If the plan sponsor of a nonfederal governmental planwhich is a group health plan to which this chapter otherwise applies makes anelection (in the form and manner as the secretary of the United StatesDepartment of Health and Human Services may prescribe by regulation), then therequirements of this subsection insofar as they apply directly to group healthplans (and not merely to group health insurance coverage) do not apply to thosegovernmental plans for the period except as provided in this section.
(3) An election applies for a single specified plan year(which may be extended through subsequent elections), or in the case of a planprovided pursuant to a collective bargaining agreement, for the term of thatagreement.
(4) Under the election in subdivision (3), the plan shallprovide for notice to enrollee (on an annual basis and at the time ofenrollment under the plan) of the fact and consequences of the election, andcertification and disclosure of creditable coverage under the plan with respectto enrollees in accordance with § 27-18.6-3(i).
(c) The requirements of this chapter do not apply to anygroup health plan (and group health insurance coverage offered in connectionwith a group health plan) in relation to its provision of limited, exceptedbenefits if the benefits are provided under a separate policy, certificate, orcontract of insurance, or are not an integral part of the plan.
(d) The requirements of this chapter do not apply to anygroup health plan (and group health insurance coverage offered in connectionwith a group health plan) in relation to its provision of noncoordinated,excepted benefits if all of the following conditions are met:
(1) The benefits are provided under a separate policy,certificate, or contract of insurance;
(2) There is no coordination between the provision ofbenefits and any exclusion of benefits under any group health plan maintainedby the same plan sponsor; and
(3) The benefits are paid with respect to an event withoutregard to whether benefits are provided with respect to that event under anygroup health plan maintained by the same plan sponsor.
(e) The requirements of this chapter do not apply to anygroup health plan (and group health insurance coverage) in relation to itsprovision of supplemental, excepted benefits if the benefits are provided undera separate policy, certificate, or contract of insurance.
(f) For purposes of this chapter, any plan, fund, or programwhich would not be (but for this subsection) an employee welfare benefit planand which is established or maintained by a partnership, to the extent that theplan, fund, or program provides medical care (including items and services paidas medical care) to present or former partners in the partnership or to theirdependents (as defined under the terms of the plan, fund or program), directlyor through insurance, reimbursement, or otherwise, shall be treated as anemployee welfare benefit plan which is a group health plan.
(2) In the case of a group health plan, the term "employer"also includes the partnership in relation to any partner.
(3) In the case of a group health plan, the term"participant" also includes:
(i) In connection with a group health plan maintained by apartnership, an individual who is a partner in relation to the partnership; or
(ii) In connection with a group health plan maintained by aself-employed individual (under which one or more employees are participants),the self-employed individual, if that individual is, or may become, eligible toreceive a benefit under the plan or the individual's beneficiaries may beeligible to receive any benefits.