(a) As used in this Code section, the term: (1) "Group contract or group plan" is synonymous with the term
"contract or plan" and means: (A) A group contract of the type issued by a nonprofit medical
service corporation established under Chapter 18 of this title; (B) A group contract of the type issued by a nonprofit hospital
service corporation established under Chapter 19 of this title; (C) A group contract of the type issued by a health care plan
established under Chapter 20 of this title; (D) A group contract of the type issued by a health maintenance
organization established under Chapter 21 of this title; or (E) A group accident and sickness insurance policy or contract,
as defined in Chapter 30 of this title. (2) "Group member" means a person who has been a member of the
group for at least six months; who is entitled to medical benefits
coverage under a group contract or group plan; and who is an
insured, certificate holder, or subscriber under the contract or
plan. (3) "Insurer" means an insurance company, nonprofit hospital
service corporation, medical service nonprofit corporation, health
care plan, or health maintenance organization. (4) "Internal Revenue Code" means the federal Internal Revenue Code as defined in Code Section 48-1-2. (5) "Plan administrator" means: (A) The person designated as the plan administrator by the
instrument under which the group contract or plan is operated;
or (B) If no plan administrator is designated, the plan sponsor. (b)(1) A group contract or plan providing coverage for hospital or medical expenses, other than coverage limited to expenses from accidents or specific diseases, which is issued, delivered, issued for delivery, or renewed in this state to provide coverage for the employees of an employer subject to the provisions of Section 4980B of the Internal Revenue Code, shall contain a provision that a group member whose insurance under the contract or plan otherwise terminates after the expiration of the period of continuation of coverage for which the individual is eligible under Code Section 33-24-21.1 or Section 4980B of the Internal Revenue Code shall be entitled to continue coverage under that group contract or plan for himself or herself and his or her eligible dependents if the group member was 60 years of age or older as of the date on which the continuation of coverage afforded under Code Section 33-24-21.1 or Section 4980B of the Internal Revenue Code commences. (2) A group member shall not be entitled to have coverage continued under paragraph (1) of this subsection if: (A) Termination of employment is voluntary for other than health
reasons; (B) Termination of coverage occurred because the employment of a
group member was terminated for reasons which would cause a
forfeiture of unemployment compensation under Chapter 8 of Title
34, the "Employment Security Law"; (C) Termination of coverage occurred because the group member
failed to pay any required contribution; (D) Any discontinued coverage is immediately replaced by similar
group coverage; or (E) The group contract or group plan was terminated in its
entirety or was terminated with respect to a class to which the
group member belonged. This paragraph shall not affect conversion rights available to a
group member under any contract or plan. (c) A group contract or plan providing coverage for hospital or
medical expenses, other than coverage limited to expenses from
accidents or specific diseases which is issued, delivered, issued
for delivery, or renewed in this state to provide coverage for the
employees of an employer subject to the provisions of Section 4980B
of the federal Internal Revenue Code, shall contain a provision
that: (1) The surviving spouse of a group member may continue coverage
under the plan, at the death of the group member, with respect to
the spouse and any dependent children whose coverage under the
plan otherwise would terminate because of the death of the group
member if the surviving spouse is 60 years of age or older at the
time of the death; and (2) The divorced spouse of a group member may continue coverage
under the plan, upon dissolution of marriage with the group
member, with respect to the divorced spouse and any dependent
children whose coverage under the plan otherwise would terminate
because of the dissolution of marriage, if the divorced spouse is
60 years of age or older at the time of the dissolution or legal
separation. (d) Each group certificate issued to each group member shall set
forth the continuation right provided in subsections (b) and (c) of
this Code section in a separate provision bearing its own caption.
The provision shall clearly set forth a full description or the
continuation right available, including all requirements,
limitations, exceptions, the premium required or a brief statement
concerning the method of calculation thereof, and the time of
payment of all premiums due during the period of continuation. (e) In the event and to the extent that this Code section is applicable, the election by the group member or divorced or surviving spouse to obtain continuation of coverage as provided under the provisions of Section 4980B of the Internal Revenue Code or under the provisions of Code Section 33-24-21.1 shall constitute election of continuation of coverage under this Code section without further action by the group member or surviving or divorced spouse. The provisions of Section 4980B of the Internal Revenue Code or of Code Section 33-24-21.1, whichever is applicable, regarding notice to a group member or a divorced or surviving spouse of the right to continue coverage shall apply to the continuation of coverage provided under this Code section. (f) If an eligible group member or the divorced or surviving spouse
elects continuation of coverage under subsection (b) or (c) of this
Code section: (1) The monthly premium for the continuation shall not be greater
than 120 percent of the total of the amount that would be charged
if the eligible group member or the divorced or surviving spouse
were a current group member and the amount that the group
policyholder would contribute toward the premium if the eligible
group member or the divorced or surviving spouse were a current
group member; (2) The first premium for the continuation of coverage under this Code section shall be paid by the eligible group member or the divorced or surviving spouse on the first regular due date following the expiration of the eligible person's benefits under the provisions of Code Section 33-24-21.1 or Section 4980B of the Internal Revenue Code; and (3) The right to continuation of coverage shall terminate upon the
earliest of any of the following: (A) The failure to pay premiums or required premium
contributions, if applicable, when due, including any grace
period allowed by the policy; (B) The date that the group plan is terminated as to all group
members, except that if a different group plan is made available
to group members, the eligible group member or the divorced or
surviving spouse shall be eligible for continuation of the same
coverage under the new plan; (C) The date on which the eligible group member or divorced or
surviving spouse becomes insured under any other group health
plan; or (D) The date on which the eligible group member or the divorced
or surviving spouse becomes eligible for federal medicare
coverage. (g) This Code section shall apply to any group contract or group
plan which covers 20 or more employees and which is issued,
delivered, issued for delivery, or renewed in this state on or after
July 1, 1992, and to any group contract or group plan covering 20 or
more employees then in effect on the first anniversary date
occurring on or after July 1, 1992. |