<html> <head> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p align=center><b>CHAPTER <a href="DisplayRule.aspx?Rule=20:06:40">20:06:40</a></b></p> <p align=center><b>&nbsp;</b></p> <p align=center><b>EMPLOYER PLANS</b></p> <p>Section</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:01">20:06:40:01</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Waiting periods, affiliation periods, and applications relating to breaks in coverage. Repealed January 1, 2014.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:01.01">20:06:40:01.01</a>&nbsp;&nbsp; Waiting periods and affiliation periods relating to breaks in coverage. Effective January 1, 2014.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:02">20:06:40:02</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Short-term, limited duration policies.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:03">20:06:40:03</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Certificates required upon losing coverage. Repealed January 1, 2014.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:03.01">20:06:40:03.01</a>&nbsp;&nbsp; Certificates required upon losing coverage. Effective January 1, 2014.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:04">20:06:40:04</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Standards for determinations on length of preexisting waiting periods.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:05">20:06:40:05</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special enrollment periods for marriage, birth, and adoption.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:05.01">20:06:40:05.01</a>&nbsp;&nbsp; Special enrollment periods for loss of other coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:06">20:06:40:06</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:07">20:06:40:07</a>&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:08">20:06:40:08</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:09">20:06:40:09</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:10">20:06:40:10</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:11">20:06:40:11</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:12">20:06:40:12</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:13">20:06:40:13</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Public health plan defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:14">20:06:40:14</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:15">20:06:40:15</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:16">20:06:40:16</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Notice describing plan s special enrollment required.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:17">20:06:40:17</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group health plans to offer breast reconstruction options after covered mastectomy.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:17.01">20:06:40:17.01</a>&nbsp;&nbsp; Written notification regarding coverage of reconstructive surgery after a mastectomy required.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:17.02">20:06:40:17.02</a>&nbsp;&nbsp; Prohibited practices.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:17.03">20:06:40:17.03</a>&nbsp;&nbsp; Not a termination of collective bargaining agreement.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:17.04">20:06:40:17.04</a>&nbsp;&nbsp; Applicability.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:18">20:06:40:18</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Claims experience defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:19">20:06:40:19</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:20">20:06:40:20</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:21">20:06:40:21</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:22">20:06:40:22</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:23">20:06:40:23</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medically necessary leave of absence defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:24">20:06:40:24</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Dependent coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:25">20:06:40:25</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Notification.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:26">20:06:40:26</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Continued application in case of changed coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:27">20:06:40:27</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Effective date.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:28">20:06:40:28</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Creditable coverage -- Children's Health Insurance Program.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:29">20:06:40:29</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:30">20:06:40:30</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group rating based on health factors.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:31">20:06:40:31</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; No group-based discrimination based on genetic information.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:32">20:06:40:32</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Limitation on requesting or requiring genetic testing.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:33">20:06:40:33</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Exceptions to requiring genetic testing.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:34">20:06:40:34</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Research exception.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:35">20:06:40:35</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Prohibitions on collection of genetic information for underwriting purposes.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:36">20:06:40:36</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medical appropriateness.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:37">20:06:40:37</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Collection of genetic information prior to or in connection with enrollment.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:38">20:06:40:38</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Incidental collection exception.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:39">20:06:40:39</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; General exception for certain small group health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:40">20:06:40:40</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability to excepted benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:41">20:06:40:41</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Effective date.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:42">20:06:40:42</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:43">20:06:40:43</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:44">20:06:40:44</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:45">20:06:40:45</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:46">20:06:40:46</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:47">20:06:40:47</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:48">20:06:40:48</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:49">20:06:40:49</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:50">20:06:40:50</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:51">20:06:40:51</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:52">20:06:40:52</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:53">20:06:40:53</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:54">20:06:40:54</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:55">20:06:40:55</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:56">20:06:40:56</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:57">20:06:40:57</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:58">20:06:40:58</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:59">20:06:40:59</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:60">20:06:40:60</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:61">20:06:40:61</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:62">20:06:40:62</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:63">20:06:40:63</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:64">20:06:40:64</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:65">20:06:40:65</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:66">20:06:40:66</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:67">20:06:40:67</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:68">20:06:40:68</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:69">20:06:40:69</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:70">20:06:40:70</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:71">20:06:40:71</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:72">20:06:40:72</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:73">20:06:40:73</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:74">20:06:40:74</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:75">20:06:40:75</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:76">20:06:40:76</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Guaranteed issue.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:77">20:06:40:77</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Disclosure requirements.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:78">20:06:40:78</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Guaranteed availability of coverage in the group market.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:79">20:06:40:79</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Denial of coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:80">20:06:40:80</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special enrollment period effective dates.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:81">20:06:40:81</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special enrollment triggers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:82">20:06:40:82</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Nonrenew or discontinuance of coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:83">20:06:40:83</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Discontinuing a particular product.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:84">20:06:40:84</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Discontinuing all coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:85">20:06:40:85</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Exception for uniform modification of coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:86">20:06:40:86</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Preexisting condition exclusion and waiting period prohibited.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:87">20:06:40:87</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Clinical trial.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:88">20:06:40:88</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Full-time equivalents treated as full-time employees.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:89">20:06:40:89</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:0A">Appendix A</a>&nbsp; Example of Certificate of Prior Group Health Plan Coverage, repealed, 39 SDR 203, effective June 10, 2013.</p> <p><a href="DisplayRule.aspx?Rule=20:06:40:0B">Appendix B</a>&nbsp; Notice of Research Exception.</p> </div> </body> </html>