SB 475

Under current law, the applicability of certain requirements related to group

health plan coverage depends on whether an individual is an “eligible employee.” For

example, an insurer that offers a group health plan to an employer or health benefit

purchasing cooperative is generally required to offer coverage to all of the employer's

or cooperative member's eligible employees and their dependents. Similarly, if the

state or a county, city, village, town, or school district offers coverage under a

self-insured health plan, the coverage must generally be offered to all eligible

employees and their dependents. Another example is that small employers with less

than ten eligible employees are exempt from the requirement to cover the treatment

of mental and substance use disorders under their group health plans. For all of

these purposes, an “eligible employee” is an individual who works on a permanent

basis and has a normal work week of at least 30 hours.

This bill amends the definition of “eligible employee” to account for the normal

work week of fire fighters. Under the bill, an individual who is employed as a

member or officer of a fire department and whose duties include fire fighting or fire

fighting training is an “eligible employee” if the individual works on a permanent

basis and has a normal work week of at least 42 hours.