Sec. 10.25.01.15. Carrier Requirements  


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  • A. To participate in the Premium Subsidy Program, a carrier shall meet the definition of a participating carrier under Regulation .02B(34) of this chapter.

    B. The written participation agreement shall include:

    (1) The carrier's designation of its subsidy administrator or administrators;

    (2) The Commission's requirement for monthly data submissions regarding premium subsidy recipients covered by the participating carrier; and

    (3) The participating carrier's agreement to cooperate with any audits of the Premium Subsidy Program.

    C. A participating carrier may not condition the sale of a wellness benefit to a small employer based on participation of the eligible employees of that small employer in wellness programs or activities.

    D. A prominent carrier shall offer at least one health benefit plan to a small employer who meets the requirements described in Regulation .04 of this chapter and shall enter into a written participation agreement with the Commission.