26.1-36.3-02. Applicability and scope

26.1-36.3-02. Applicability and scope

1. This chapter and section 26.1-36-37.2 apply to any health benefit plan that provides

coverage to the employees of a small employer in this state if:

a. Any portion of the premium or benefits is paid by or on behalf of the small

employer;

b. An eligible employee or dependent is reimbursed, whether through wage

adjustments or otherwise, by or on behalf of the small employer for any portion of

the premium; or

c. The health benefit plan is treated by the employer or any of the eligible

employees or dependents as part of a plan or program for the purposes of

section 106, 125, or 162 of the United States Internal Revenue Code.

2. a. Except as provided in subdivision b, carriers that are affiliated companies or that

are eligible to file a consolidated tax return must be treated as one carrier and

any restrictions or limitations imposed by this chapter and section 26.1-36-37.2

apply as if all health benefit plans delivered or issued for delivery to small

employers in this state by the affiliated carriers were issued by one carrier.

b. An affiliated carrier that is a health maintenance organization having a certificate

of authority may be considered to be a separate carrier for the purposes of this

chapter and section 26.1-36-37.2.

c. Unless otherwise authorized by the commissioner, a small employer carrier may

not enter into one or more ceding arrangements with respect to health benefit

plans delivered or issued for delivery to small employers in this state if the

arrangements would result in less than fifty percent of the insurance obligation or

risk for the health benefit plans being retained by the ceding carrier.

3. a. A Taft Hartley trust, or a carrier with the written authorization of that trust, may

make a written request to the commissioner for a waiver from the application of

any of the provisions of subsection 1 of section 26.1-36.3-04 with respect to a

health benefit plan provided to the trust.

b. The commissioner may grant the waiver if the commissioner finds that application

of subsection 1 of section 26.1-36.3-04, with respect to the trust:

(1) Would have a substantial adverse effect on the participants and

beneficiaries of that trust; and

(2) Would require significant modifications to one or more collective bargaining

arrangements under which the trust is established or maintained.

c. A waiver granted under this section does not apply to a person who participates

in the trust as an associate member of an employee organization.