Sec. 31.11.04.06. Conditions of Coverage  


Latest version.
  • A. In order to receive the benefits provided under the group contract, an insured shall elect coverage not later than 45 days after the applicable change in status.

    B. The coverage shall be retroactive to the applicable change in status.

    C. The request to the employer under §A of this regulation shall be in writing and signed by the insured.

    D. Continuation coverage shall be provided without evidence of insurability or additional waiting periods.

    E. Costs to Insured.

    (1) The insured shall pay to the employer the employer's entire cost for the coverage to be provided.

    (2) The entire cost to the employer includes the employer's customary contribution as well as the contribution customarily required of an employee if there were no applicable change in status.

    (3) The entire cost to the employer may include a reasonable administrative fee not to exceed 2 percent of the amount permitted under §E(2) of this regulation.

    F. The insured may elect to pay the employer the amount due for the cost of the coverage in monthly installments.

    G. In addition to the allowable cost provided for under §E of this regulation, the first payment to the employer by the insured shall include the cost for the coverage provided after the change in status and until the end of the month in which the insured makes an election.