Health plans - Wyoming

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, also apply. State laws include the following provisions:

• The plan must not refuse coverage of children on the grounds that the children were born out of wedlock; are not claimed as a dependent on the parent's federal tax return; or do not reside with the parent or in the insurer's service area. (§26-15-135)
• The plan must not discriminate on the basis of health status; medical condition, including both physical and mental illness; claims experience; receipt of health care; medical history; genetic information; evidence of insurability, including conditions arising out of acts of domestic violence; or disability. (§26-19-107)
• The plan must cover colorectal cancer and prostate examinations and laboratory tests for cancer for nonsymptomatic participants, with no deductible and reimbursement of up to $250. (§26-19-107)
• The plan must not, based on the genetic testing information of an individual or a family member of an individual, deny eligibility; adjust premium rates; adjust contribution rates; or request or require predictive genetic testing information. (§26-19-107)
• If the plan covers dependents, it must cover newly born children from the moment of birth including congenital defects and birth abnormalities, and adopted children from the earlier of the date the petition for adoption is filed or entry of the child in the adoptive home. (§26-20-101)
• The plan must cover equipment, supplies and outpatient self-management training and education, including medical nutrition therapy for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using diabetes if prescribed by a health care professional. (§26-20-201)
• If the plan provides for reimbursement for health services, reimbursement must not be denied if services are provided by a person licensed under the laws of this state to treat the illness or disability or perform the health services covered by the contract or policy. This includes licensed professionals such as dieticians, as well as optometrists, chiropractors, podiatrists, audiologists, hearing aid specialists, pharmacists, physical therapists, and speech pathologists. (§26-22-101)
• If the plan covers diagnostic and therapeutic services, it must cover services rendered by a doctor of medicine or a psychologist. (§26-22-104)
• If the plan covers dependents, it must dependents regardless of age, while they are incapable of self-sustaining employment by reason of mental retardation or physical handicap; and chiefly dependent upon the insured for support and maintenance. (§26-22-401)
• Any group may contract with an insurer, preferred provider organization or health maintenance organization for provision of medical services outside of Wyoming for the insureds of that group, provided the insureds are not restricted from utilizing any Wyoming provider who provides the same health care services. (§26-22-503)

State

Contact

Wyoming Insurance Department

Regulations

Wyoming Statutes

Title 26 Insurance Code

Chapter 19 Group and Blanket Disability Insurance

Chapter 20 Mandated Coverage

Chapter 22 Hospital or Medical Service Insurance and Prepaid Health Service Plans

Title 33 Professions and Occupations

Chapter 9 Podiatrists

Chapter 10 Chiropractors

Chapter 15 Dentists and Dental Hygienists

Chapter 23 Optometrists

Chapter 24 Pharmacy

Chapter 25 Physical Therapists

Chapter 27 Psychologists

Chapter 32 Eye Care Practitioners

Chapter 33 Speech Pathologists and Audiologists

Chapter 35 Hearing Aid Specialist Licensure

Chapter 38 Professional Counselors, Marriage and Family Therapists, Social Workers and Chemical Dependency Specialists

www.lexisnexis.com/hottopics/wystatutes/

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

29 CFR chapter XXV (Parts 2509 – 2590)