(1) EMPLOYEE BECOMES ELIGIBLE AFTER COMMENCEMENT OF COVERAGE. Unless otherwise permitted by rule of the commissioner, if an insurer provides coverage under a group health benefit plan, the insurer shall provide coverage under the group health benefit plan to an eligible employee who becomes eligible for coverage after the commencement of the employer’s coverage, and to the eligible employee’s dependents, regardless of health condition or claims experience, if all of the following apply: (a) The employee has satisfied any applicable waiting period. (b) The employer agrees to pay the premium required for coverage of the employee under the group health benefit plan. (3) STATE OR MUNICIPAL SELF-INSURED PLANS. If the state or a county, city, village, town or school district provides coverage under a self-insured health plan, it shall provide coverage under the self-insured health plan to an eligible employee who waived coverage during an enrollment period during which the employee was entitled to enroll in the self-insured health plan, regardless of health condition or claims experience, if all of the following apply: (a) The eligible employee was covered as a dependent under creditable coverage when he or she waived coverage under the self-insured health plan. (b) The eligible employee’s coverage under the creditable coverage has terminated or will terminate due to a divorce from the insured under the creditable coverage, the death of the insured under the creditable coverage, loss of employment by the insured under the creditable coverage or involuntary loss of coverage under the creditable coverage by the insured under the creditable coverage. (c) The eligible employee applies for coverage under the selfinsured health plan not more than 30 days after termination of his or her coverage under the creditable coverage.
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