Title 15. Health Insurance — Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-401 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–401LinkCopy Citation
(a)
In this section, “date of adoption” means the earlier of:
(1)
a judicial decree of adoption; or
(2)
the assumption of custody, pending adoption, of a prospective adoptive child by a prospective adoptive parent.
(b)
(1)
This subsection applies to:
(i)
each individual health insurance policy that:
(1)
is delivered, issued for delivery, or renewed in the State;
(2)
provides coverage on an expense–incurred basis; and
(3)
provides coverage for a family member of the insured;
(ii)
each group health insurance policy, including a contract issued by a nonprofit health service plan, that:
(1)
is delivered, issued for delivery, or renewed in the State;
(2)
provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and
(3)
provides coverage for a family member of a covered employee or member;
(iii)
each individual service or indemnity contract that:
(1)
is delivered, issued for delivery, or renewed in the State by a nonprofit health service plan; and
(2)
provides coverage for a family member of the subscriber;
(iv)
each individual contract that:
(1)
is delivered, issued for delivery, or renewed in the State by a health maintenance organization; and
(2)
provides coverage for a family member of the subscriber; and
(v)
each group contract that:
(1)
is delivered, issued for delivery, or renewed in the State by a health maintenance organization;
(2)
provides coverage for employees of an employer or employers or members of a union or unions; and
(3)
provides coverage for a family member of the covered employee or member.
(2)
Each policy or contract subject to this subsection shall provide that the health insurance benefits applicable:
(i)
for children or grandchildren shall be payable for a newly born or newly adopted dependent child or grandchild from the moment of birth or date of adoption of the child or grandchild; and
(ii)
for a minor for whom guardianship is granted by court or testamentary appointment shall be payable from the date of appointment.
(c)
On request, an insurer or nonprofit health service plan that issues an individual or group health insurance policy that provides coverage on an expense–incurred basis, or a health maintenance organization that issues an individual or group contract, shall offer family members’ coverage to an insured, subscriber, or member regardless of the marital status of the insured, subscriber, or member.
(d)
Each insurer, nonprofit health service plan, or health maintenance organization that issues a policy or contract that does not provide family members’ coverage shall:
(1)
provide notice to the policyholder or contract holder that coverage for a newly born or newly adopted child or grandchild or a minor for whom guardianship is granted by court or testamentary appointment is not provided under the policy or contract; and
(2)
inform the insured, subscriber, or member of the right and conditions to purchase family members’ coverage under this section.
(e)
To be eligible for coverage under this section:
(1)
a grandchild must be a dependent, and in the court–ordered custody, of the insured, subscriber, or member; and
(2)
a minor must be a dependent and in the custody of the insured, subscriber, or member as a result of a guardianship, other than a temporary guardianship of less than 12 months duration, granted by court or testamentary appointment.
(f)
Coverage for a newly born or newly adopted child or grandchild or a minor for whom guardianship is granted by court or testamentary appointment shall consist of coverage for injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.
(g)
If payment of a specific premium or subscription fee is required to provide coverage for a child or grandchild or a minor for whom guardianship is granted by court or testamentary appointment, the policy or contract may require notification of a birth, adoption, or appointment and payment of the required premium or fee to the insurer, nonprofit health service plan, or health maintenance organization within 31 days after the date of birth, date of adoption, or date of court or testamentary appointment in order to continue coverage beyond the 31–day period.
(h)
(1)
An insurer, nonprofit health service plan, or health maintenance organization may require proof that the insured, subscriber, or member is the parent or grandparent of a newly born or newly adopted child or grandchild or guardian of a minor under court or testamentary appointment.
(2)
If the insurer, nonprofit health service plan, or health maintenance organization requires proof under this subsection, the insurer, nonprofit health service plan, or health maintenance organization shall pay the cost of the proof.
Md. Code Ann., Ins. § 15-402 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–402LinkCopy Citation
(a)
This section applies to:
(1)
each individual or group health insurance policy that is issued in the State; and
(2)
each contract that is issued in the State by a nonprofit health service plan or a health maintenance organization.
(b)
(1)
Notwithstanding any limiting age stated in a policy or contract subject to this section, a child, grandchild, or individual for whom guardianship is granted by court or testamentary appointment shall continue to be covered under the policy or contract as a dependent of an employee, member, or other covered individual if the child, grandchild, or individual under guardianship:
(i)
is unmarried;
(ii)
is chiefly dependent for support on the employee, member, or other covered individual; and
(iii)
at the time of reaching the limiting age, is incapable of self–support because of mental or physical incapacity that started before the child, grandchild, or individual under guardianship attained the limiting age.
(2)
A child, grandchild, or individual under guardianship who is covered under this section shall continue to be covered while remaining unmarried, dependent, and mentally or physically incapacitated until the coverage on the employee, member, or other covered individual on whom the child, grandchild, or individual under guardianship is dependent terminates.
(c)
To be eligible for coverage under this section:
(1)
a grandchild must be a dependent, and in the court–ordered custody, of the employee, member, or other covered individual; and
(2)
an individual must be a dependent and in the custody of the employee, member, or other covered individual as a result of a guardianship, other than a temporary guardianship of less than 12 months duration, granted by court or testamentary appointment.
Md. Code Ann., Ins. § 15-403 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–403LinkCopy Citation
(a)
This section applies to:
(1)
each individual health insurance policy that:
(i)
provides coverage on an expense–incurred basis; and
(ii)
provides coverage for a family member of the insured;
(2)
each group health insurance policy that:
(i)
provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and
(ii)
provides coverage for a family member of a covered employee or member;
(3)
each individual service or indemnity contract that:
(i)
is issued by a nonprofit health service plan; and
(ii)
provides coverage for a family member of the subscriber;
(4)
each individual contract that:
(i)
is issued by a health maintenance organization; and
(ii)
provides coverage for a family member of the subscriber; and
(5)
each group contract that:
(i)
is issued by a health maintenance organization;
(ii)
provides coverage for employees of an employer or employers or members of a union or unions; and
(iii)
provides coverage for a family member of the covered employee or member.
(b)
Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available, on request of the insured, subscriber, employee, or member, to a grandchild who:
(1)
is unmarried;
(2)
is in the court–ordered custody of the insured, subscriber, employee, or member;
(3)
resides with the insured, subscriber, employee, or member;
(4)
is the dependent of the insured, subscriber, employee, or member; and
(5)
has not attained the limiting age under the terms of the policy or contract.
(c)
On request, an insurer that issues an individual or group health insurance policy that provides coverage on an expense–incurred basis, a nonprofit health service plan, or a health maintenance organization shall offer family members’ coverage to an insured or subscriber regardless of the marital status of the insured or subscriber.
(d)
(1)
An insurer, nonprofit health service plan, or health maintenance organization may require proof that the insured or subscriber is the grandparent of the grandchild.
(2)
If the insurer, nonprofit health service plan, or health maintenance organization requires proof under this subsection, the insurer, nonprofit health service plan, or health maintenance organization shall pay the cost of the proof.
Md. Code Ann., Ins. § 15-403.1 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–403.1LinkCopy Citation
(a)
This section applies to:
(1)
each individual health insurance policy that:
(i)
provides coverage on an expense–incurred basis; and
(ii)
provides coverage for a family member of the insured;
(2)
each group health insurance policy that:
(i)
provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and
(ii)
provides coverage for a family member of a covered employee or member;
(3)
each individual service or indemnity contract that:
(i)
is issued by a nonprofit health service plan; and
(ii)
provides coverage for a family member of the subscriber;
(4)
each individual contract that:
(i)
is issued by a health maintenance organization; and
(ii)
provides coverage for a family member of the subscriber; and
(5)
each group contract that:
(i)
is issued by a health maintenance organization;
(ii)
provides coverage for employees of an employer or employers or members of a union or unions; and
(iii)
provides coverage for a family member of the covered employee or member.
(b)
Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available, on request of the insured, subscriber, employee, or member, to an individual who:
(1)
is unmarried;
(2)
is under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months duration, of the insured, subscriber, employee, or member;
(3)
resides with the insured, subscriber, employee, or member;
(4)
is the dependent of the insured, subscriber, employee, or member; and
(5)
has not attained the limiting age under the terms of the policy or contract.
(c)
On request, an insurer that issues an individual or group health insurance policy that provides coverage on an expense–incurred basis, a nonprofit health service plan, or a health maintenance organization shall offer family members’ coverage to an insured or subscriber regardless of the marital status of the insured or subscriber.
(d)
(1)
An insurer, nonprofit health service plan, or health maintenance organization may require proof that the insured or subscriber is a guardian under court or testamentary appointment.
(2)
If the insurer, nonprofit health service plan, or health maintenance organization requires proof under this subsection, the insurer, nonprofit health service plan, or health maintenance organization shall pay the cost of the proof.
Md. Code Ann., Ins. § 15-403.2 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–403.2LinkCopy Citation
(a)
In this section, “child dependent of the domestic partner” means an individual who:
(1)
is:
(i)
the natural child, stepchild, adopted child, or grandchild of the domestic partner of an insured;
(ii)
a child placed with the domestic partner of an insured for legal adoption; or
(iii)
a child who is under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months’ duration, of the domestic partner of an insured;
(2)
is a dependent, as that term is used in 26 U.S.C. §§ 104, 105, and 106, and any regulations adopted under those sections, of the domestic partner of an insured;
(3)
resides with the insured;
(4)
is unmarried; and
(5)
is under the age of 25 years.
(b)
This section applies to each individual or group policy or contract that:
(1)
allows family coverage; and
(2)
is issued by:
(i)
an insurer or nonprofit health service plan that provides inpatient hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; or
(ii)
a health maintenance organization that provides inpatient hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(c)
Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available to a domestic partner of an insured or a child dependent of the domestic partner of an insured at the request of:
(1)
an insured under an individual policy or contract that is subject to this section; or
(2)
the group policyholder of a group policy or contract that is subject to this section.
(d)
An insurer, nonprofit health service plan, or health maintenance organization may require a group policyholder that requests coverage for a domestic partner or child dependent of the domestic partner of an insured under subsection (c)(2) of this section to provide proof of the eligibility of the domestic partner or child dependent of the domestic partner for coverage under this section.
(e)
The Commissioner shall adopt regulations to implement this section.
Md. Code Ann., Ins. § 15-404 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–404LinkCopy Citation
(a)
This section applies to:
(1)
each group or blanket health insurance policy that is issued or delivered in the State and provides coverage on an expense-incurred basis; and
(2)
each group medical or major medical contract or certificate that is issued or delivered in the State by a nonprofit health service plan.
(b)
Each policy, contract, or certificate subject to this section shall provide a benefit that allows the addition of a certificate holder’s or subscriber’s dependent children to the certificate holder’s or subscriber’s policy or contract at any time and without evidence of insurability if:
(1)
the dependent children previously were covered under the policy or contract of the certificate holder’s or subscriber’s spouse; and
(2)
the certificate holder’s or subscriber’s spouse has died.
(c)
This section applies regardless of whether a certificate holder’s or subscriber’s dependent children are eligible for any continuation or conversion privileges under the policy or contract of the certificate holder’s or subscriber’s spouse.
(d)
Within 6 months after the death of the spouse, the certificate holder or subscriber must exercise the benefit provided under this section.
Md. Code Ann., Ins. § 15-405 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–405LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Carrier” means:
(i)
an insurer that holds a certificate of authority in the State and provides health insurance in the State;
(ii)
a health maintenance organization that is licensed to operate in the State; or
(iii)
a nonprofit health service plan that is licensed to operate in the State.
(3)
“Health insurance coverage” means health care coverage under which medical care services can be provided to a child.
(4)
“Insuring parent” means a parent who:
(i)
is required under a court or administrative order to provide health insurance coverage for a child; or
(ii)
otherwise provides health insurance coverage for a child.
(5)
“Medical support notice” means a notice that is:
(i)
in a format prescribed by federal law; and
(ii)
issued by a child support agency to enforce the health insurance coverage provisions of a child support order.
(6)
“Order” means a ruling that:
(i)
is issued by a court of this State or another state or an administrative agency of another state; and
(ii)
(1)
creates or recognizes the right of a child to receive benefits under a parent’s health insurance coverage; or
(2)
establishes a parent’s obligation to pay child support and provide health insurance coverage for a child.
(7)
“Qualified medical support order” means a medical child support order issued under State law that complies with § 609(a) of the Employee Retirement Income Security Act of 1974 (ERISA).
(b)
This section applies to:
(1)
insurers, nonprofit health service plans, and health maintenance organizations that operate in the State under a certificate of authority;
(2)
group health plans, as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 (ERISA); and
(3)
persons that offer a service benefit plan, as defined in federal law.
(c)
If a parent eligible for family members’ coverage is required under an order to provide health insurance coverage for a child, an entity subject to this section:
(1)
shall allow the insuring parent to enroll in family members’ coverage and include the child in that coverage regardless of enrollment period restrictions;
(2)
if the insuring parent is enrolled in health insurance coverage but does not include the child in the enrollment, shall:
(i)
allow the noninsuring parent, child support enforcement agency, or Maryland Department of Health to apply for enrollment on behalf of the child; and
(ii)
include the child in the coverage regardless of enrollment period restrictions; and
(3)
may not terminate health insurance coverage for the child unless written evidence is provided to the entity that:
(i)
the order is no longer in effect;
(ii)
the child has been or will be enrolled under other reasonable health insurance coverage that will take effect on or before the effective date of the termination;
(iii)
the employer has eliminated family members’ coverage for all of its employees; or
(iv)
the employer no longer employs the insuring parent, except that if the parent elects to exercise the provisions of the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), coverage shall be provided for the child consistent with the employer’s plan for postemployment health insurance coverage for dependents.
(d)
Notwithstanding any other provision of this article, an entity subject to this section may not deny enrollment of a child under the health insurance coverage of an insuring parent because the child:
(1)
was born out of wedlock;
(2)
is not claimed as a dependent on the insuring parent’s federal income tax return;
(3)
does not reside with the insuring parent or in the service area of the entity; or
(4)
is receiving benefits or is eligible to receive benefits under the Maryland Medical Assistance Program.
(e)
If a child has health insurance coverage through an insuring parent, an entity subject to this section shall:
(1)
provide to the noninsuring parent membership cards, claims forms, and any other information necessary for the child to obtain benefits through the health insurance coverage; and
(2)
process the claims forms and make appropriate payment to the noninsuring parent, health care provider, or Maryland Department of Health if the noninsuring parent incurs expenses for health care provided to the child.
(f)
Within 20 business days after receipt of a medical support notice from an employer, the carrier:
(1)
shall determine whether the medical support notice contains:
(i)
the employee’s name and mailing address; and
(ii)
the child’s name and the child’s mailing address or the address of a substituted official;
(2)
if the medical support notice does not contain the information described in paragraph (1) of this subsection, shall complete and forward the appropriate part of the medical support notice to the issuing child support enforcement agency advising that the medical support notice does not constitute a qualified medical child support order; and
(3)
if the medical support notice contains the information described in paragraph (1) of this subsection, shall comply with the following requirements:
(i)
determine the child’s eligibility for enrollment;
(ii)
complete and send the appropriate part of the medical support notice to the employer and the Child Support Administration;
(iii)
enroll the child if the child is eligible for enrollment, subject to subsection (g) of this section;
(iv)
send to the employee, child, and custodial parent of the child a written notice that explains that the coverage of the child is or will become available to the child; and
(v)
send to the custodial parent of the child a written description of:
(1)
the health insurance coverage;
(2)
the effective date of coverage;
(3)
the employee’s cost for the health insurance coverage; and
(4)
if not already provided:
(A)
a summary plan description;
(B)
any forms, documents, or information necessary to effectuate coverage; and
(C)
any information necessary to submit claims for benefits.
(g)
If the employee’s eligibility for health insurance coverage is subject to a waiting period that has not been completed, the carrier:
(1)
shall complete and send the appropriate part of the medical support notice to the employer and the issuing child support agency within 20 business days after receipt of the medical support notice from the employer; and
(2)
on the employee’s satisfaction of the waiting period, shall complete enrollment of the child in accordance with this section and send the notice and information required under subsection (f)(3) of this section.
(h)
If the employee’s health insurance plan requires that the employee be enrolled in order for the child to be enrolled and the employee is not currently enrolled, the carrier shall enroll both the employee and the child, without regard to enrollment period restrictions, within the time period specified in subsection (f) of this section.
(i)
If a child is eligible for enrollment, the carrier shall complete the enrollment without regard to enrollment period restrictions, within the time periods specified in subsections (f) and (g) of this section.
(j)
The requirement for notification of the child under subsection (f)(3)(iv) of this section may be satisfied by notifying the custodial parent if the child and the custodial parent live at the same address.
Md. Code Ann., Ins. § 15-406 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–406LinkCopy Citation
(a)
In this section, “health insurance coverage” means health care coverage under which medical care services can be provided to a child.
(b)
This section applies to:
(1)
commercial insurers, nonprofit health service plans, and health maintenance organizations that operate in the State under a certificate of authority;
(2)
group health plans, as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 (ERISA); and
(3)
persons that offer a service benefit plan, as defined in federal law.
(c)
An entity subject to this section may not consider whether an individual is eligible for or receives medical assistance from this State or another state under 42 U.S.C. § 1396a when:
(1)
determining the eligibility of the individual for enrollment in health insurance coverage; or
(2)
calculating any payments for benefits for which the individual is eligible under the health insurance coverage.
(d)
On presentation of a claim, an entity subject to this section shall reimburse the State to the extent that:
(1)
the State has paid for expenses for health care services that are provided to an eligible individual and covered under the Maryland Medical Assistance Program; and
(2)
those health care services are included under the individual’s health insurance coverage provided by the entity.
(e)
If a State agency has been assigned the rights of an individual who is eligible for medical assistance and who has health insurance coverage provided by an entity subject to this section, the entity may not impose on the State agency requirements that are different from the requirements that apply to an insurance producer, assignee, or any other individual who has health insurance coverage provided by the entity.
Md. Code Ann., Ins. § 15-407 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–407LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Dependent child” means a child of the insured who:
(i)
was covered under a group contract as a qualified or eligible dependent of the insured immediately before the death of the insured; or
(ii)
was born to a qualified secondary beneficiary defined in paragraph (5)(i) of this subsection after the death of the insured.
(3)
“Group contract” means:
(i)
an insurance contract or policy that is issued or delivered in the State to the employer of the insured by an insurer or nonprofit health service plan and that provides group hospital, medical, or surgical benefits to the employees of the employer on an expense–incurred basis; or
(ii)
a contract between the employer of the insured and a health maintenance organization certified under Title 19, Subtitle 7 of the Health – General Article that provides hospital, medical, or surgical benefits to the employees of the employer.
(4)
“Insured” means an employee who is a resident of the State and covered under a current or predecessor group contract with the same employer for at least 3 months before death.
(5)
“Qualified secondary beneficiary” means an individual who is:
(i)
a beneficiary under the group contract as the spouse of the insured for at least 30 days immediately preceding the death of the insured; or
(ii)
a dependent child of the insured.
(b)
(1)
Each group contract in force on the date of the death of the insured shall provide continuation coverage in accordance with this section.
(2)
Subject to subsection (c) of this section, if continuation coverage is elected by or on behalf of a qualified secondary beneficiary, the group contract shall provide continuation coverage to the qualified secondary beneficiary after the death of the insured.
(c)
Continuation coverage that is elected by or on behalf of a qualified secondary beneficiary under the group contract shall begin on the date of the death of the insured and end on the earliest of the following:
(1)
18 months after the date of the death of the insured;
(2)
the date on which the qualified secondary beneficiary fails to make timely payment of an amount required under subsection (d)(2) of this section;
(3)
the date on which the qualified secondary beneficiary becomes eligible for hospital, medical, or surgical benefits under an insured or self–insured group health benefit program or plan, other than the group contract, that is written on an expense–incurred basis or is with a health maintenance organization;
(4)
the date on which the qualified secondary beneficiary becomes entitled to benefits under Title XVIII of the Social Security Act;
(5)
the date on which the qualified secondary beneficiary accepts hospital, medical, or surgical coverage under a nongroup contract or policy that is written on an expense–incurred basis or is with a health maintenance organization;
(6)
the date on which the qualified secondary beneficiary elects to terminate coverage under the group contract;
(7)
the date on which the employer ceases to provide benefits to its employees under a group contract; or
(8)
for an individual who is a qualified secondary beneficiary by reason of having been a dependent child, the date on which the individual would no longer be covered under the group contract if the insured had not died.
(d)
Continuation coverage under this section shall:
(1)
be provided without evidence of insurability or additional waiting periods;
(2)
require the qualified secondary beneficiary to pay to the employer an amount that does not exceed:
(i)
the sum of the employer contribution and any contribution that the insured would have been required to pay if the insured had not died; and
(ii)
a reasonable administrative fee that is subject to review and approval by the Commissioner;
(3)
allow the payment of the amount specified in paragraph (2) of this subsection in monthly installments if the qualified secondary beneficiary elects to do so; and
(4)
be identical to the coverage offered under the group contract to similarly situated individuals for whom there has not been a death of the insured.
(e)
(1)
To elect continuation coverage provided under this section, a qualified secondary beneficiary or authorized representative shall submit a signed election notification form to the insured’s employer during the election period.
(2)
The election period for continuation coverage under this section begins on the date of the death of the insured and ends at least 45 days after that date.
(3)
Within 14 days after receipt of a request for an election notification form, the employer shall deliver or send by first–class mail the election notification form to the qualified secondary beneficiary or authorized representative.
(f)
Each certificate issued to an insured under a group contract shall include a statement, in a manner and form approved by the Commissioner, that advises the insured of the following:
(1)
the availability of continuation coverage under this section;
(2)
a summary of the eligibility for and duration of the continuation coverage; and
(3)
the procedure for making an election to receive continuation coverage if the insured dies.
(g)
The Commissioner shall:
(1)
publish at least annually in the Maryland Register and in a newspaper of general circulation in each county notice that describes the continuation coverage required under this section;
(2)
prescribe by regulation the form and content of the election notification form; and
(3)
make election notification forms available to each employer whose employees are covered by a group contract.
(h)
Notice of the availability of continuation coverage under this section shall be provided by:
(1)
the Secretary of Health as specified in § 4–217 of the Health – General Article; and
(2)
licensed funeral directors as specified in § 7–407 of the Health Occupations Article.
(i)
An employer that fails to provide notice or an election notification form under this section is not liable to a qualified secondary beneficiary or the insured for benefits that otherwise would have been payable or for other damages that result from the failure to provide the notice or form.
(j)
An employer that terminates continuation coverage after notice or nonpayment of an amount required under subsection (d)(2) of this section by a qualified secondary beneficiary, or an insurer that terminates continuation coverage after notice by the employer, is not liable to a qualified secondary beneficiary for benefits that otherwise would have been payable under this section if the termination:
(1)
is made in good faith;
(2)
is reasonable under the circumstances; and
(3)
is not the result of a mutual or material mistake of fact.
(k)
This section does not affect or limit the right of a qualified secondary beneficiary to conversion privileges under a group contract.
Md. Code Ann., Ins. § 15-408 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–408LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Change in status” means the divorce of the insured and the insured’s spouse.
(3)
“Dependent child” means a child of the insured who:
(i)
was covered under a group contract as a qualified or eligible dependent of the insured immediately before the change in status; or
(ii)
was born to a qualified secondary beneficiary defined in paragraph (6)(i) of this subsection after the change in status.
(4)
“Group contract” means:
(i)
an insurance contract or policy that is issued or delivered in the State to the employer of the insured by an insurer or nonprofit health service plan and that provides group hospital, medical, or surgical benefits to the insured on an expense-incurred basis; or
(ii)
a contract between the employer of the insured and a health maintenance organization certified under Title 19, Subtitle 7 of the Health - General Article that provides group hospital, medical, or surgical benefits offered to the insured.
(5)
“Insured” means an employee who is a resident of the State and covered under a group contract.
(6)
“Qualified secondary beneficiary” means an individual who is:
(i)
a beneficiary under the group contract as the spouse of the insured for at least 30 days immediately preceding the change in status; or
(ii)
a dependent child of the insured.
(7)
“Termination statement” means written notice of an event specified in subsection (c) of this section that is:
(i)
provided to the employer on a form that the Commissioner prescribes; and
(ii)
(1)
signed by the insured and a qualified secondary beneficiary defined in paragraph (6)(i) of this subsection; or
(2)
accompanied by the insured’s signed and sworn affidavit that verifies all facts in the termination statement.
(b)
(1)
Each group contract in force on the date of the change in status shall provide continuation coverage in accordance with this section.
(2)
Subject to subsection (c) of this section, a qualified secondary beneficiary is entitled to continuation coverage under a group contract after a change in status.
(3)
Paragraph (2) of this subsection does not apply while the insured is not covered by a group contract.
(c)
Continuation coverage under this section shall begin on the date of the change in status and end on the earliest of the following:
(1)
the date on which the qualified secondary beneficiary becomes eligible for hospital, medical, or surgical benefits under an insured or self-insured group health benefit program or plan, other than the group contract, that is written on an expense-incurred basis or is with a health maintenance organization;
(2)
the date on which the qualified secondary beneficiary becomes entitled to benefits under Title XVIII of the Social Security Act;
(3)
the date on which the qualified secondary beneficiary accepts hospital, medical, or surgical coverage under a nongroup contract or policy that is written on an expense-incurred basis or is with a health maintenance organization;
(4)
the date on which the qualified secondary beneficiary elects to terminate coverage under the group contract;
(5)
for an individual who is a qualified secondary beneficiary by reason of having been a dependent child, the date on which the individual would no longer be covered under the group contract if there had not been a change in status; or
(6)
for an individual who is a qualified secondary beneficiary by reason of having been the insured’s spouse, the date on which the individual remarries.
(d)
Continuation coverage under this section shall be identical to the coverage offered under the group contract to similarly situated beneficiaries for whom there has not been a change in status.
(e)
(1)
From the date of the change in status until the date on which a termination statement is received by the employer, the insured shall pay to the employer, through payroll deduction or otherwise as determined by the employer, the sum of the employer’s contribution for a qualified secondary beneficiary defined in subsection (a)(6)(i) of this section and the amount of contribution that would have been paid by the insured if there had not been a change in status.
(2)
The additional costs payable by the insured under paragraph (1) of this subsection may be allocated between the insured and a qualified secondary beneficiary who was the insured’s spouse or may be reimbursed in full to the insured by the qualified secondary beneficiary by agreement between the parties or, as equity may require, by court order under Title 10, Title 11, or Title 12 of the Family Law Article at the time of the change in status or after the change in status.
(f)
Each certificate issued to an insured under a group contract shall include a statement, in a manner and form approved by the Commissioner, that advises the insured of the following:
(1)
the availability of continuation coverage under this section; and
(2)
a summary of the eligibility for and duration of the continuation coverage.
(g)
The Commissioner shall:
(1)
publish at least annually in the Maryland Register and in a newspaper of general circulation in each county notice that describes the continuation coverage required under this section;
(2)
prescribe by regulation the form and content of the termination statement; and
(3)
make termination statement forms available to each employer whose employees are covered by a group contract.
(h)
(1)
On request of a qualified secondary beneficiary, from the date of the change in status until the date on which a termination statement is received by the employer, the employer shall make available to the qualified secondary beneficiary forms for submitting claims to the group contract insurer.
(2)
On presentation of a divorce decree by a qualified secondary beneficiary, the group contract insurer may reimburse the qualified secondary beneficiary directly for hospital, medical, or surgical expenses that the qualified secondary beneficiary has paid.
(3)
A group contract insurer that reimburses a qualified secondary beneficiary in accordance with this subsection is not liable to any other party for payment for the same services.
(4)
If the insured receives reimbursement from the group contract insurer for hospital, medical, or surgical expenses that a qualified secondary beneficiary has paid, the insured immediately shall pay the reimbursement to the qualified secondary beneficiary unless a written agreement or court order provides otherwise.
(i)
(1)
An employer that terminates continuation coverage after notice by the insured or qualified secondary beneficiary, or an insurer that terminates continuation coverage after notice by the employer, is not liable to the insured or qualified secondary beneficiary for benefits that otherwise would have been payable under this section if the termination:
(i)
is made in good faith;
(ii)
is reasonable under the circumstances; and
(iii)
is not the result of a mutual or material mistake of fact.
(2)
Notwithstanding paragraph (1) of this subsection, receipt by the employer of a termination statement is conclusive evidence of termination, and neither the employer nor the insurer is liable to the qualified secondary beneficiary or insured for benefits that otherwise would have been payable under this section.
(j)
This section does not affect or limit the right of a qualified secondary beneficiary to conversion privileges under a group contract.
Md. Code Ann., Ins. § 15-409 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–409LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
(i)
“Change in status” means the termination of the insured’s employment other than for cause.
(ii)
“Change in status” includes:
(1)
involuntary termination of the insured’s employment other than for cause; and
(2)
voluntary termination of the insured’s employment by the insured employee.
(3)
“Group contract” means:
(i)
an insurance contract or policy that is issued or delivered in the State to the employer of the insured by an insurer or nonprofit health service plan and that provides group hospital, medical, or surgical benefits to the employees of the employer on an expense–incurred basis; or
(ii)
a contract between the employer of an insured and a health maintenance organization certified under Title 19, Subtitle 7 of the Health – General Article that provides group hospital, medical, or surgical benefits to the employees of the employer.
(4)
“Insured” means an employee who is a resident of the State and covered under a current or predecessor group contract with the same employer for at least 3 months before the change in status.
(b)
(1)
Each group contract in force on the date of the change in status shall provide continuation coverage in accordance with this section.
(2)
Subject to subsection (c) of this section, if continuation coverage is elected by or on behalf of an insured, the group contract shall provide continuation coverage to the insured after a change in status.
(c)
Continuation coverage that is elected by or on behalf of the insured under the group contract shall begin on the date of the change in status and end on the earliest of the following:
(1)
18 months after the date of the change in status;
(2)
the date on which the insured fails to make timely payment of an amount required under subsection (d)(2) of this section;
(3)
the date on which the insured becomes eligible for hospital, medical, or surgical benefits under an insured or self–insured group health benefit program or plan, other than the group contract, that is written on an expense–incurred basis or is with a health maintenance organization;
(4)
the date on which the insured becomes entitled to benefits under Title XVIII of the Social Security Act;
(5)
the date on which the insured accepts hospital, medical, or surgical coverage under a nongroup contract or policy that is written on an expense–incurred basis or is with a health maintenance organization;
(6)
the date on which the insured elects to terminate coverage under the group contract; or
(7)
the date on which the employer ceases to provide benefits to its employees under a group contract.
(d)
Continuation coverage under this section shall:
(1)
be provided without evidence of insurability or additional waiting periods;
(2)
require the insured to pay to the employer an amount that does not exceed:
(i)
the sum of the employer contribution and any contribution that the insured would have been required to pay if there had not been a change in status; and
(ii)
a reasonable administrative fee that is subject to review and approval by the Commissioner;
(3)
allow the payment of the amount specified in item (2) of this subsection in monthly installments if the insured elects to do so;
(4)
be identical to the coverage offered under the group contract to similarly situated individuals for whom there has not been a change in status; and
(5)
be available to the spouse and dependent children of the insured if:
(i)
the group contract provides benefits for spouses and dependent children; and
(ii)
the insured’s spouse and dependent children were covered under the group contract before the change in status.
(e)
(1)
To elect continuation coverage provided under this section, an insured or authorized representative shall submit a signed election notification form to the insured’s employer during the election period.
(2)
The election period for continuation coverage under this section begins on the date of the change in status and ends at least 45 days after that date.
(3)
Within 14 days after receipt of a request for an election notification form, the employer shall deliver or send by first–class mail the election notification form to the insured or authorized representative.
(f)
Each certificate issued to an insured under a group contract shall include a statement, in a manner and form approved by the Commissioner, that advises the insured of the following:
(1)
the availability of continuation coverage under this section;
(2)
a summary of the eligibility for and duration of the continuation coverage; and
(3)
the procedure for making an election to receive continuation coverage if a change in status occurs.
(g)
The Commissioner shall:
(1)
publish at least annually in the Maryland Register and in a newspaper of general circulation in each county notice that describes the continuation coverage required under this section;
(2)
prescribe by regulation the form and content of the election notification form; and
(3)
make election notification forms available to each employer whose employees are covered by a group contract.
(h)
Notice of the availability of continuation coverage under this section shall be provided by:
(1)
the employer; and
(2)
the Secretary of Labor as specified in § 8–805(c) of the Labor and Employment Article.
(i)
An employer that fails to provide notice or an election notification form under this section is not liable to the insured or any other covered individual for benefits that otherwise would have been payable or for other damages that result from the failure to provide the notice or form.
(j)
An employer that terminates continuation coverage after notice or nonpayment of an amount required under subsection (d)(2) of this section by the insured or other covered individual, or an insurer that terminates continuation coverage after notice by the employer, is not liable to the insured or other covered individual for benefits that otherwise would have been payable under this section if the termination:
(1)
is made in good faith;
(2)
is reasonable under the circumstances; and
(3)
is not the result of a mutual or material mistake of fact.
(k)
This section does not affect or limit the right of an insured to conversion privileges under a group contract.
Md. Code Ann., Ins. § 15-409.1 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–409.1LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Act” means the federal American Recovery and Reinvestment Act of 2009 (P.L. 111–5).
(3)
“Carrier” means:
(i)
an insurer;
(ii)
a nonprofit health service plan; or
(iii)
a health maintenance organization.
(4)
“Small employer” has the meaning stated in § 15–1201 of this title.
(b)
This section applies to a carrier that issues health benefit plans to small employers in accordance with Subtitle 12 of this title.
(c)
A carrier shall allow an extended election period for continuation coverage under § 15–409 of this subtitle if the individual:
(1)
was involuntarily terminated from employment by a small employer between September 1, 2008, and February 16, 2009, inclusive, as described in § 3001(a)(3)(C) of the Act;
(2)
is an assistance eligible individual, as defined in § 3001(a)(3) of the Act, or would be an assistance eligible individual if an election of continuation coverage under § 15–409 of this subtitle was in effect on the date of enactment of the Act; and
(3)
was eligible for continuation coverage under § 15–409 of this subtitle at the time of the individual’s termination of employment.
(d)
The extended election period provided under this section shall continue until 60 days after provision of the notification required by § 3001(a)(7)(C) of the Act if the notification describes the extended election period required under this section.
(e)
Any continuation coverage elected by an individual during an extended election period under this section:
(1)
shall begin during the first period of coverage beginning on or after the individual’s election of continuation coverage; and
(2)
may not extend beyond the period of continuation coverage that would have been required under § 15–409 of this subtitle if the coverage had been elected as required under that section.
Md. Code Ann., Ins. § 15-411 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–411LinkCopy Citation
(a)
Each group health insurance contract or policy that is issued by an insurer or nonprofit health service plan shall provide continuous open enrollment for the purpose of allowing a married employee who is enrolled under the contract or policy to alter the terms of the employee’s coverage to include the employee’s spouse or children if the employee’s spouse loses coverage under another group health insurance contract or policy because of the involuntary termination of the spouse’s employment other than for cause.
(b)
A group health insurance contract or policy may not require evidence of insurability for a spouse who qualifies for group health insurance coverage under this section.
(c)
A married employee who wishes to alter the terms of the employee’s coverage under this section shall notify the employer within 6 months after the date on which the coverage of the employee’s spouse under another group health insurance contract or policy terminates.
Md. Code Ann., Ins. § 15-413 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–413LinkCopy Citation
(a)
(1)
Except as provided in paragraph (2) of this subsection, this section applies to each group health insurance policy that:
(i)
(1)
is issued or delivered in the State;
(2)
is issued to a policyholder that is incorporated or has a main office in the State; or
(3)
covers individuals who reside or work in the State; and
(ii)
provides benefits in the event of the disability of an individual covered under the policy.
(2)
This section does not apply to:
(i)
a policy issued under Title 13 of this article if the insurance under the policy is terminated because of the prepayment or refinancing, wholly or partly, with the same creditor of a prior debt; or
(ii)
except as the Commissioner provides by regulation, a group policy issued to an employer to cover its employees.
(b)
Each group policy subject to this section shall provide that a covered individual whose coverage under the group policy is terminated for any reason other than failure of the covered individual to pay a required premium or contribution is entitled, without evidence of insurability, to an individual policy of disability income insurance.
(c)
By regulation the Commissioner may exempt from the requirements of this section certain types of group policies that the Commissioner considers appropriate.
(d)
(1)
An individual policy issued under this section shall take effect immediately after the termination of coverage under the group policy if the covered individual:
(i)
makes a timely written request for an individual policy; and
(ii)
pays the first premium for the individual policy.
(2)
By regulation the Commissioner shall establish rules to determine when a written request and payment of the required premium are timely.
(e)
An individual policy issued under this section shall be guaranteed renewable for the term or to the limiting age for which benefits would have been provided if coverage under the group policy had not terminated.
(f)
The level of benefits under an individual policy issued under this section shall equal approximately the disability benefits that would have been provided if coverage under the group policy had not terminated.
(g)
(1)
The premium for an individual policy issued under this section shall be determined in accordance with the insurer’s table of premium rates that is applicable to the attained age and class of risk of the covered individual for the type and amount of insurance provided.
(2)
The insurer shall reserve the right to change the premium on any policy anniversary subject to approval by the Commissioner.
(h)
The Commissioner may establish requirements that govern notification by the insurer or group policyholder to the individual whose coverage under the group policy is being terminated of the right of conversion to an individual policy.
(i)
The insurer may limit the right of conversion to individuals who have been covered under the group policy for at least 1 year.
(j)
Each group health insurance policy that was issued before January 1, 1984, shall be amended to comply with the requirements of this section on the first policy renewal anniversary date on or after January 1, 1984.
Md. Code Ann., Ins. § 15-416 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–416LinkCopy Citation
(a)
This section applies to insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery in the State individual, group, or blanket health insurance policies and contracts.
(b)
At least 60 days before a child who is covered under a parent’s individual, group, or blanket health insurance policy or contract reaches the limiting age under the policy or contract, an entity subject to this section shall:
(1)
notify the parent of criteria under which a child may remain eligible for coverage as a dependent under the policy or contract; and
(2)
provide information regarding:
(i)
any other policies that may be available to the child from the entity; and
(ii)
the availability of additional information from the Administration regarding individual policies in the State.
(c)
The Commissioner shall establish and publish by bulletin the notice to be given under this section.
Md. Code Ann., Ins. § 15-417 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–417LinkCopy Citation
(a)
This section applies to:
(1)
insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
(2)
health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(b)
An entity subject to this section that provides health benefits to full-time students over the age of 18 may not exclude health benefits for a student over the age of 18 who:
(1)
is enrolled less than full time as a result of a documented disability that prevents the student from maintaining a full-time course load; and
(2)
is maintaining a course load of at least 7 credit hours per semester.
(c)
An entity subject to this section may require the insured, subscriber, or enrollee to provide verification of the disability from a disability services professional employed by the institution of higher education that the student attends or a health care provider with special expertise in and knowledge of the disability.
Md. Code Ann., Ins. § 15-418 (2026)
Title 15. Health Insurance
Subtitle 4. Eligibility for Coverage; Continuation and Conversion of Policies
§ 15–418LinkCopy Citation
(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)
“Child dependent” means an individual who:
(i)
is:
(1)
the grandchild of the insured; or
(2)
a child who is entitled to dependent coverage under § 15–403.1 of this subtitle;
(ii)
is unmarried; and
(iii)
is under the age of 25 years.
(b)
(1)
This section applies to:
(i)
each policy of individual or group health insurance that is issued in the State;
(ii)
each contract that is issued in the State by a nonprofit health service plan; and
(iii)
each contract that is issued in the State by a health maintenance organization.
(2)
Notwithstanding paragraph (1) of this subsection, this section does not apply to:
(i)
a contract covering one or more, or any combination of the following:
(1)
coverage only for loss caused by an accident;
(2)
disability coverage;
(3)
credit–only insurance; or
(4)
long–term care coverage; or
(ii)
the following benefits if they are provided under a separate contract:
(1)
dental coverage;
(2)
vision coverage;
(3)
Medicare supplement insurance;
(4)
coverage limited to benefits for a specified disease or diseases;
(5)
travel accident or sickness coverage; and
(6)
fixed indemnity limited benefit insurance that does not provide benefits on an expense incurred basis.
(c)
Each policy or contract subject to this section that provides coverage for dependents shall:
(1)
include coverage for a child dependent;
(2)
provide the same health insurance benefits to a child dependent that are available to any other covered dependent; and
(3)
provide health insurance benefits to a child dependent at the same rate or premium applicable to any other covered dependent.
(d)
This section does not limit or alter any right to dependent coverage or to the continuation of coverage that is otherwise provided for in this article.