31.11.02.06

.06 Conditions of Coverage.

A. In order to receive the benefits provided under the group contract, an insured employee, or the divorced spouse of the insured employee, shall notify the employer of the applicable change in status not later than:

(1) 60 days after the applicable change in status if on the date of the applicable change in status the employee is covered under the employer's group contract or under another group contract issued to the same employer replacing that contract. The coverage shall be retroactive to the applicable change in status.

(2) 30 days after the date the insured employee becomes eligible for coverage under a group contract issued to another employer, if the insured employee becomes covered under the new employer's group contract after the applicable change in status. The coverage shall be retroactive to the date of eligibility.

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

C. Costs Paid to Employer.

(1) The insured employee or the qualified secondary beneficiary 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 changes in status.

(3) If the insurer quotes rates to the employer separately for individual coverage and for dependent coverage, the payment to be made on behalf of the qualified secondary beneficiary shall be the rate quoted for dependents.

(4) If the insurer quotes a family rate which would normally include an employee and eligible dependents, the amount payable on behalf of the qualified secondary beneficiary shall be the difference between the family rate and the rate payable for an individual employee who is not covered for dependents.

(5) If, in connection with a divorce, there is a court order or an agreement between the insured and the insured's spouse as to the allocation of the cost of the insurance coverage between the insured employee and the spouse, payment to the employer shall be made in accordance with the terms of the court order or the agreement.

D. Payment to the employer for the cost of the coverage is due and shall be paid on or before the first day of each month for which coverage is to be provided unless the employer agrees in writing to payment at a later date. The following apply:

(1) If the employer customarily collects employee contributions under the group contract on a quarterly basis, the required payment is due and shall be paid on or before the first day of each quarter for which coverage is to be provided.

(2) At the time of the notice referred to in §A of this regulation, payment will be due on the date notice is given. On that date the amount of payment due shall be the accumulated charges to cover the period beginning with the effective date of the coverage to be provided to the end of the month in which the notice is given.