# Insurance (GIN)

## Title 15. Health Insurance

### Subtitle 11. Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans

#### Section 15-1102

(a) In this section, "employee" includes:

  (1) an officer, manager, or retired employee of an employer;

  (2) a sole proprietor if the employer is a sole proprietorship; and

  (3) a partner if the employer is a partnership.

(b) Health insurance on a franchise plan is the form of health insurance:

  (1) that is issued to:

    (i) three or more employees of a corporation, partnership, sole proprietorship, or governmental corporation, agency, or department; or

    (ii) ten or more members, employees, or employees of members of a labor union, or trade, professional, or other association, that is organized in good faith for purposes other than obtaining insurance, has a constitution or bylaws, and has had an active existence for at least 2 years;

  (2) under which the individuals insured, with or without their dependents, are issued the same form of an individual policy that varies only as to amounts and kinds of coverage applied for; and

  (3) under which the premiums on the individual policies may be paid to the insurer periodically by:

    (i) the employer, with or without payroll deductions;

    (ii) the labor union or association for its members; or

    (iii) a designated person acting on behalf of the employer, labor union, or association.

#### Section 15-1103

(a) In this section, "transportation ticket policy" means a ticket policy of health insurance that:

  (1) has as its dominant feature the protection of the insured from a transportation hazard; and

  (2) is sold at transportation stations, ticket offices, or travel bureaus by:

    (i) vending machines;

    (ii) employees of railroads, steam lines, airlines, or other organizations engaged in transporting individuals on common carriers;

    (iii) individuals or employees of persons engaged in selling transportation on common carriers; or

    (iv) other qualified agents.

(b) A transportation ticket policy may not be issued or delivered in the State unless it conforms to the requirements and provisions of Sec.Sec. 15-102, 15-201, 15-202, 15-203, 15-205, and 15-207 through 15-226 of this title, subject to Sec. 15-202(c) of this title that relates to inapplicable or inconsistent provisions.

#### Section 15-1104

(a)

  (1) In this section the following words have the  meanings indicated.

  (2) "Employer sponsored health benefit plan" means any  plan, fund, or program that:

    (i) is established or maintained by an employer  under the Employee Retirement Income Security Act of 1974;

    (ii) offers coverage for health benefits; and

    (iii) is treated by the employer or any eligible employee or dependent as part of a plan, fund, or program under  the United States Internal Revenue Code, 26 U.S.C. Sec. 106, Sec. 125, or Sec.  162.

  (3) "Group health insurance" has the meaning stated in Sec. 15-302 of this title.

  (4) "Limited benefit group health insurance contract"  means a group health insurance contract that provides health  insurance benefits, but is not required to provide all the benefits  required under Subtitles 7 and 8 of this title.

  (5) "Special eligible employee" means an employee who:

    (i) is eligible for health coverage under the terms of an employer sponsored health benefit plan;

    (ii) works:

      (1) on a temporary or substitute basis; or

      (2) less than 30 hours in a normal workweek;  and

    (iii) is not eligible for coverage under any group health insurance contract, nonprofit health service plan  contract, or health maintenance organization contract issued to  the employee's employer because the employee meets the criteria of item (ii) of this paragraph.

(b) A limited benefit group health insurance contract may be  issued only by an insurer or nonprofit health service plan to an  employer if the limited group health insurance contract is issued  to provide health coverage only for:

  (1) special eligible employees; or

  (2) special eligible employees and their dependents.

(c) An insurer or nonprofit health service plan that sells a limited benefit group health insurance contract, as a condition of  sale, may require the employer to:

  (1) collect payment for premiums due under the limited benefit group health insurance contract through payroll  deduction;

  (2) contribute to the premium payments applicable to  the coverage of a special eligible employee; and

  (3) offer coverage to any dependent of a special  eligible employee.

(d) A limited benefit group health insurance contract shall  comply with:

  (1) this title, except Subtitles 7 and 8 of this title; and

  (2) notwithstanding item (1) of this subsection, Sec.Sec. 15-802, 15-812, 15-815, 15-830, 15-831, 15-832, and 15-833 of this title.

(e) An insurer or nonprofit health service plan shall  disclose in the group certificate and in enrollment material  provided to each special eligible employee that the limited benefit  group health insurance contract does not provide comprehensive  health coverage.

#### Section 15-1106

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Carrier" means:

    (i) an insurer;

    (ii) a nonprofit health service plan; or

    (iii) a health maintenance organization.

  (3) "Evidence of individual insurability" has the meaning stated in Sec. 15-1105 of this subtitle.

  (4) "Health benefit plan" has the meaning stated in Sec. 15-1301 of this title.

(b) If a carrier conditions coverage for a health benefit plan on evidence of individual insurability, the carrier may not rescind a contract or a certificate on the basis of written information submitted on or with, or omitted from, an application for the health benefit plan unless the carrier completed medical underwriting and resolved all reasonable medical questions related to the written information submitted on or with, or omitted from, the application before issuing the health benefit plan.

(c) The carrier shall have the burden of persuasion that its rescission of a health benefit plan complies with subsection (b) of this section.

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Md. Code Ann., Ins. (as displayed at mgaleg.maryland.gov, October 16, 2026)