Small Employer: Guaranteed Issue, Enrollment and Fair Marketing

Every small employer carrier must issue all employer health benefit plans on a guaranteed-issue basis (the statute's guaranteed-issue text covers groups of 2–50 eligible employees; one-life groups enroll through a limited annual open-enrollment window); riders adding benefits MAY be medically underwritten but attach only to the standard plan. Per the note, a late enrollee (for employers with fewer than two employees) may be excluded no longer than twenty-four (24) months if not continuously covered by creditable coverage within 63 days before the new effective date. Enrollment: an initial enrollment period of at least 30 days; an annual 30-day open enrollment; and a special enrollment period when prior coverage ended (COBRA exhausted; loss of eligibility through legal separation, divorce, death, termination, or reduced hours; or employer contributions ended) — requested within 30 days of termination. Required disclosures: premium-change provisions and rating factors, renewability, preexisting-condition provisions, and all plans the employer qualifies for. Carriers may decline only for listed reasons (outside the geographic service area — no smaller than a county; no in-network capacity; or inadequate financial reserves applied uniformly — which locks the carrier out of the small-group market for 180 days). Fair marketing: no steering employers away (or toward another carrier) because of health status, claims experience, industry, occupation, or geographic location; no agent compensation or contract termination based on those factors; never encourage firing an employee to get coverage; denials require written notice with reasons. Rates: modified community rating, unchangeable for twelve (12) months unless group composition or benefits change, applied to all eligible employees and dependents. Employees may decline coverage — then wait for open enrollment or a qualifying event. Employers with 50 or more employees must offer health insurance; smaller employers are not required to.

Take every group, rate them by the book, leave the rate alone for a year, and never nudge the sick ones toward the competition.