The national Group Health Insurance guide covers how group plans work: eligibility, the master contract and certificates, federal COBRA, HIPAA and coordination of benefits. This guide covers the Wyoming rules:

• eligible groups
• state continuation for non-COBRA groups
• conversion
• the small-employer market (Title 26, ch. 19)

Eligible groups (26-19-102)

• Employer groups: a noncontributory plan must cover all eligible employees except those who reject coverage in writing.
• Association groups:
  • at least 50 eligible people at issue
  • bylaws calling for at least annual meetings
  • voting rights for members
• Payment to providers: the policy may pay hospital, nursing, medical or surgical benefits directly to the provider, unless the insured objects in writing by the time proof of loss is filed (26-19-109).

State continuation (26-19-113)

Wyoming's continuation law applies to group policies not subject to federal COBRA.

Eligibility:

• An employee or member who was insured continuously for the three months before eligibility ended.
• Not available to someone covered by Medicare, though their spouse and children remain eligible, or covered by another group plan.

Election and cost:

• The person asks in writing and pays the first contribution within 31 days after coverage ends.
• Contributions are paid monthly in advance and can't exceed 102% of the group rate.

Duration: coverage ends at the earliest of:

• 12 months after it would have ended
• failure to pay
• termination of the group policy

Conversion: when continuation ends, the member may convert by notifying the carrier and paying within 31 days.

Small employers (26-19-301 to 26-19-306)

• A small employer had at least 2 and no more than 50 eligible employees on at least half of its working days in the preceding calendar quarter.
• Each small employer carrier must actively offer at least two plans: a basic plan and a standard plan.
• A carrier must offer coverage to all eligible employees, not just some of them, except late enrollees as allowed.
• Nonrenewal is allowed for nonpayment, fraud, failing participation or contribution rules, or misuse of a network. Health status isn't a valid reason.
• A carrier that leaves the small-employer market can't write new small-employer business for five years.

Common exam traps

• Wyoming continuation covers non-COBRA groups and lasts 12 months, not 18.
• It requires 3 months of prior coverage, an election within 31 days, and a cost of no more than 102%.
• A person on Medicare can't continue, but their spouse and children can.
• Association groups need 50 people.
• A small employer has 2 to 50 employees. A carrier that exits the market is barred for 5 years.