LD 335
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LD 335 Title Page An Act To Clarify the Definition of "Eligible Group" in Small Group Health Insu... Page 2 of 3
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LR 1319
Item 1

 
Be it enacted by the People of the State of Maine as follows:

 
Sec. 1. 24-A MRSA §2808-B, sub-§1, ¶D, as repealed and replaced by PL
2003, c. 428, Pt. H, §5, is amended to read:

 
D. "Eligible group" means any person, firm, corporation,
partnership, association or subgroup engaged actively in a
business that employed an average of 50 or fewer eligible
employees during the preceding calendar year, the majority
of whom were employed within this State.

 
(1) If an employer was not in existence throughout the
preceding calendar year, the determination must be
based on the average number of employees that the
employer is reasonably expected to employ on business
days in the current calendar year.

 
(2) In determining the number of eligible employees,
companies that are affiliated companies or that are
eligible to file a combined tax return for purposes of
state taxation are considered one employer.

 
(3) A group is not an eligible group if there is any
one other state where there are more eligible employees
than are employed within this State and the group had
coverage in that state or is eligible for guaranteed
issuance of coverage in that state.

 
(4) An employer qualifies as an eligible group for 2-
person coverage if the employer provides a carrier with
the following information demonstrating that the
employer's business and employees meet the minimum
qualifications for group coverage in paragraph C:

 
(a) A copy of the most recent quarterly combined
filing for income tax withholding and unemployment
contributions, Form 941/C1-ME;

 
(b) For an employee claimed to be an employee
eligible for group coverage whose name is not
listed on Form 941/C1-ME, a copy of the employer's
payroll records for the most recent 3 months
showing tax withholding or a wage report from a
payroll company showing wages paid to that
employee for the most recent quarter with tax
withholding;

 
(c) If an employer is exempt from filing Form 941/C1-ME for
group coverage, documentation of that exemption and a copy of the
employer's


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