Ins 3.375(6)(d)(d) Notice of election. An insurer offering a group health benefit plan or a self-insured governmental health plan shall provide the applicable notice to the employer who qualifies for and elects an increased cost exemption under s. 632.89 (3c), Stats. The insurer shall inform the employer to notify promptly all enrollees under the plan of the exemption not to exceed 30-days following the cost increase determination and exemption election.
Ins 3.375(6)(d)1.1. The notice shall be in substantially the form outlined in Appendix 2, using a standard typeface with at least a 10-point font, indicating the exemption election and that the plan will comply with benefit coverage requirements contained in s. 632.89 (2), 2007 Stats.
Ins 3.375(6)(d)2.2. The notice shall be provided to each plan enrollee in either electronic or paper form.
Ins 3.375(6)(d)3.3. The notice shall also be posted in a prominent position in each workplace of the employer.
Ins 3.375(7)(7)Small Employer Exemption.
Ins 3.375(7)(a)(a) Employer request. An employer having fewer than 10 eligible employees on the first day of the plan year may elect an exemption from compliance with s. 632.89, Stats. An insurer offering a group health benefit plan or self-funded government plan shall inform the employer that in lieu of those requirements, the plan may cover benefits for nervous and mental disorders and substance use disorders in accordance with the requirements contained in s. 632.89 (2), 2007 Stats.
Ins 3.375(7)(b)(b) Notice of election. An insurer offering a group health benefit plan or a self-insured governmental health plan shall provide the applicable notice to the employer who qualifies for and elects the small employer exemption under s. 632.89 (3f), Stats. The insurer shall inform the employer to notify promptly all enrollees under the plan of the exemption not to exceed 30 days from the employer’s determination to elect exemption. The notice shall comply with all of the following:
Ins 3.375(7)(b)1.1. The notice shall be in substantially the form outlined in Appendix 1, using a standard typeface with at least a 10-point font, indicating the exemption election and that the plan will cover benefits for nervous and mental disorders and substance use disorders in accordance with the requirements contained in s. 632.89 (2), 2007 Stats.
Ins 3.375(7)(b)2.2. The notice shall be provided to each plan enrollee in either electronic or paper form.
Ins 3.375(7)(b)3.3. The notice shall be posted in a prominent position in each workplace of the employer.
Ins 3.375 HistoryHistory: EmR1043: emerg. cr., eff. 11-29-10; CR 10-149: cr. Register June 2011 No. 666, eff. 7-1-11.
Ins 3.375 Appendix 1
Small Employer Notice of the Plan’s Election of Exemption from Mental Health and Substance Use Disorder Parity for [This Plan Year]
You are receiving this notice as an employee of [name of employer group]. This notice is to inform you that [name of employer group] qualifies and elects to be exempt from the state nervous and mental disorders and substance use disorders coverage parity requirements for this plan year, beginning [insert date of the first day of the plan year]. The employer is eligible to elect this exemption based upon having fewer than 10 eligible employees. Benefits may change as of [insert the date of the first day of the plan year].
Despite the exemption from the state nervous and mental disorders and substance use disorders coverage requirements, state law requires [name of employer group] to comply with the minimum mandated coverage requirements and limitations contained in s. 632.89 (2), 2007 Stats., for treatment services for nervous and mental disorders and substance use disorders.
For this plan year, your plan provides the following coverage related to nervous and mental disorders and substance use disorders:
[Insert plain language benefits summary]
Carefully review your health plan’s benefits, limitations, and exclusions for detailed information on services and coverage available to you and your family this plan year. If you have additional questions please contact [insert contact name, phone number and e-mail address if available].
Ins 3.375 Appendix 2
Group Health Benefit Plan Notice of Election of Exemption from Mental Health and Substance Use Disorder Parity for [This Plan Year]
You are receiving this notice as an employee of [name of employer group]. This notice is to inform you that [name of employer group] qualifies and elects to be exempt from the state nervous and mental disorders and substance use disorders coverage parity requirements for this plan year, beginning [insert date of the first day of the plan year].
A group health benefit plan may elect to be exempt from mental health and substance use disorder parity if there are increases in the employer’s total cost of coverage for the treatment of physical conditions and nervous and mental disorders and substance use disorders by a percentage that exceeds either two percent (2%) in the first plan year in which the nervous and mental disorders and substance use disorders coverage requirements apply or one percent (1%) in any plan year after the first plan year in which the requirements apply. Benefits may change as of [insert the date of the first day of the plan year].
Despite the exemption from the state nervous and mental disorders and substance use disorders coverage requirements, state law requires [name of employer group] to comply with the minimum mandated coverage requirements and limitations contained in s. 632.89 (2), 2007 Stats., for treatment services for nervous and mental disorders and substance use disorders.
For this plan year, your plan provides the following coverage related to nervous and mental disorders and substance use disorders:
[Insert plain language benefits summary]
Carefully review your health plan’s benefits, limitations, and exclusions for detailed information on services and coverage available to you and your family this plan year. If you have additional questions please contact [insert contact name, phone number and e-mail address if available].
Ins 3.38Ins 3.38Coverage of newborn infants.
Ins 3.38(1)(1)Purpose. This section is intended to interpret and implement s. 632.895 (5), Stats.
Ins 3.38(2)(2)Interpretation and implementation.