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<section article="gin" article_name="Insurance" number="15-1208.1" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <text>A carrier shall provide the special enrollment periods described in this section in each small employer health benefit plan.</text>
  </level>
  <level label="b">
    <text>A carrier shall allow an eligible employee or dependent who is eligible, but not enrolled, for coverage under the terms of the employer’s health benefit plan to enroll for coverage under the terms of the plan if:</text>
    <level label="1">
      <text>the eligible employee or dependent was covered under an employer–sponsored plan or group health benefit plan at the time coverage was previously offered to the employee or dependent;</text>
    </level>
    <level label="2">
      <text>the eligible employee states in writing, at the time coverage was previously offered, that coverage under an employer–sponsored plan or group health benefit plan was the reason for declining enrollment, but only if the plan sponsor or carrier requires the statement and provides the employee with notice of the requirement;</text>
    </level>
    <level label="3">
      <text>the eligible employee’s or dependent’s coverage described in item (1) of this subsection:</text>
      <level label="i">
        <text>was under a COBRA continuation provision, and the coverage under that provision was exhausted; or</text>
      </level>
      <level label="ii">
        <text>was not under a COBRA continuation provision, and either the coverage was terminated as a result of loss of eligibility for the coverage, including loss of eligibility as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or employer contributions towards the coverage were terminated; and</text>
      </level>
    </level>
    <level label="4">
      <text>under the terms of the plan, the eligible employee requests enrollment not later than 30 days after:</text>
      <level label="i">
        <text>the date of exhaustion of coverage described in item (3)(i) of this subsection; or</text>
      </level>
      <level label="ii">
        <text>termination of coverage or termination of employer contributions described in item (3)(ii) of this subsection.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>All small employer health benefit plans shall provide a special enrollment period during which the following individuals may be enrolled under the health benefit plan:</text>
    <level label="1">
      <text>an individual who becomes a dependent of the eligible employee through marriage, birth, adoption, placement for adoption, or placement for foster care;</text>
    </level>
    <level label="2">
      <text>an eligible employee who acquires a new dependent through marriage, birth, adoption, placement for adoption, placement for foster care, or through a child support order or other court order;</text>
    </level>
    <level label="3">
      <text>the spouse of an eligible employee at the birth or adoption of a child, placement of a child for foster care, or through a child support order or other court order, provided the spouse is otherwise eligible for coverage;</text>
    </level>
    <level label="4">
      <text>at the option of the SHOP Exchange, an enrollee who is the eligible employee or the spouse of the eligible employee, if:</text>
      <level label="i">
        <text>the enrollee loses a dependent or is no longer considered to be a dependent due to divorce or legal separation; or</text>
      </level>
      <level label="ii">
        <text>the employee or the employee’s dependent dies; and</text>
      </level>
    </level>
    <level label="5">
      <level label="i">
        <text>an eligible employee who becomes pregnant, as confirmed by a health care practitioner; and</text>
      </level>
      <level label="ii">
        <text>an eligible employee’s spouse or dependent who becomes pregnant, as confirmed by a health care practitioner, provided the spouse or dependent is otherwise eligible for coverage.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>An eligible employee may not enroll a dependent during a special enrollment period unless the eligible employee:</text>
    <level label="1">
      <text>is enrolled under the health benefit plan; or</text>
    </level>
    <level label="2">
      <text>applies for coverage for the eligible employee during the same special enrollment period.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>The special enrollment period under subsection (c)(1) through (4) of this section shall be a period of not less than 31 days and shall begin on the later of:</text>
      <level label="i">
        <text>the date dependent coverage is made available; or</text>
      </level>
      <level label="ii">
        <text>the date of the marriage, birth, adoption, placement for adoption, placement for foster care, child support order or other court order, divorce, legal separation, or death, whichever is applicable.</text>
      </level>
    </level>
    <level label="2">
      <text>The special enrollment period under subsection (c)(5) of this section shall:</text>
      <level label="i">
        <text>be open for a period of 90 days; and</text>
      </level>
      <level label="ii">
        <text>begin on the date a health care practitioner confirms the pregnancy.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <level label="1">
      <text>If an eligible employee enrolls any of the individuals described in subsection (c)(1) through (4) of this section during the first 31 days of the special enrollment period, the coverage shall become effective as follows:</text>
      <level label="i">
        <text>in the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;</text>
      </level>
      <level label="ii">
        <text>in the case of a dependent’s birth, as of the date of the dependent’s birth;</text>
      </level>
      <level label="iii">
        <text>in the case of a dependent’s adoption or placement for adoption, the date of adoption or placement for adoption, whichever occurs first;</text>
      </level>
      <level label="iv">
        <text>in the case of a dependent’s placement for foster care, the date of placement; and</text>
      </level>
      <level label="v">
        <text>in the case of a dependent added due to a child support order or any other court order:</text>
        <level label="1">
          <text>the date the child support order or other court order is effective; or</text>
        </level>
        <level label="2">
          <text>for SHOP Exchange plans, if allowed by the SHOP Exchange and selected by the eligible employee, the first day of the month following receipt of the plan selection.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>If an eligible employee enrolls an individual described in subsection (c)(5) of this section in a health benefit plan, the coverage shall become effective on the first day of the month in which the individual receives confirmation of pregnancy.</text>
    </level>
  </level>
  <level label="g">
    <text>If the SHOP Exchange allows the special enrollment periods described in subsection (c)(4) of this section, the coverage shall become effective as follows:</text>
    <level label="1">
      <text>for special enrollment periods in the SHOP Exchange due to death of the employee or dependent, the first day of the month following plan selection; and</text>
    </level>
    <level label="2">
      <text>for special enrollment periods in the SHOP Exchange due to divorce or legal separation, the first day of the month following receipt of the plan selection.</text>
    </level>
  </level>
</section>
