Sec. 31.11.04.05. Coverage Provided  


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  • A. The coverage provided shall be identical to the coverage offered under the group contract to similarly situated individuals for whom there has been no applicable change in status.

    B. If the group policy provides benefits for spouses and dependent children, the coverage provided shall be available to the insured's:

    (1) Spouse if the spouse was covered under the group policy before the applicable change in status; and

    (2) Dependent children if the insured had coverage for dependent children before the applicable change in status.

    C. If the employer transfers from one group contract to another, the coverage provided the insured will be transferred to that coverage provided under the new group contract.

    D. If the employer provides various hospital, surgical, medical, or major medical coverages under one or more group contracts, an insured may not elect to choose less than all of the benefits provided unless the insured would have had the option of making such a choice if there had been no applicable change in status.

    E. The benefits to be provided under the group contract shall be in no respect less favorable than those required by these regulations.