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<section article="gin" article_name="Insurance" number="15-401" title_number="15" title_name="Health Insurance" subtitle_number="4" subtitle_name="Eligibility for Coverage; Continuation and Conversion of Policies">
  <level label="a">
    <text>In this section, “date of adoption” means the earlier of:</text>
    <level label="1">
      <text>a judicial decree of adoption; or</text>
    </level>
    <level label="2">
      <text>the assumption of custody, pending adoption, of a prospective adoptive child by a prospective adoptive parent.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>This subsection applies to:</text>
      <level label="i">
        <text>each individual health insurance policy that:</text>
        <level label="1">
          <text>is delivered, issued for delivery, or renewed in the State;</text>
        </level>
        <level label="2">
          <text>provides coverage on an expense–incurred basis; and</text>
        </level>
        <level label="3">
          <text>provides coverage for a family member of the insured;</text>
        </level>
      </level>
      <level label="ii">
        <text>each group health insurance policy, including a contract issued by a nonprofit health service plan, that:</text>
        <level label="1">
          <text>is delivered, issued for delivery, or renewed in the State;</text>
        </level>
        <level label="2">
          <text>provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and</text>
        </level>
        <level label="3">
          <text>provides coverage for a family member of a covered employee or member;</text>
        </level>
      </level>
      <level label="iii">
        <text>each individual service or indemnity contract that:</text>
        <level label="1">
          <text>is delivered, issued for delivery, or renewed in the State by a nonprofit health service plan; and</text>
        </level>
        <level label="2">
          <text>provides coverage for a family member of the subscriber;</text>
        </level>
      </level>
      <level label="iv">
        <text>each individual contract that:</text>
        <level label="1">
          <text>is delivered, issued for delivery, or renewed in the State by a health maintenance organization; and</text>
        </level>
        <level label="2">
          <text>provides coverage for a family member of the subscriber; and</text>
        </level>
      </level>
      <level label="v">
        <text>each group contract that:</text>
        <level label="1">
          <text>is delivered, issued for delivery, or renewed in the State by a health maintenance organization;</text>
        </level>
        <level label="2">
          <text>provides coverage for employees of an employer or employers or members of a union or unions; and</text>
        </level>
        <level label="3">
          <text>provides coverage for a family member of the covered employee or member.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>Each policy or contract subject to this subsection shall provide that the health insurance benefits applicable:</text>
      <level label="i">
        <text>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</text>
      </level>
      <level label="ii">
        <text>for a minor for whom guardianship is granted by court or testamentary appointment shall be payable from the date of appointment.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>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.</text>
  </level>
  <level label="d">
    <text>Each insurer, nonprofit health service plan, or health maintenance organization that issues a policy or contract that does not provide family members’ coverage shall:</text>
    <level label="1">
      <text>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</text>
    </level>
    <level label="2">
      <text>inform the insured, subscriber, or member of the right and conditions to purchase family members’ coverage under this section.</text>
    </level>
  </level>
  <level label="e">
    <text>To be eligible for coverage under this section:</text>
    <level label="1">
      <text>a grandchild must be a dependent, and in the court–ordered custody, of the insured, subscriber, or member; and</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
  </level>
  <level label="f">
    <text>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.</text>
  </level>
  <level label="g">
    <text>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.</text>
  </level>
  <level label="h">
    <level label="1">
      <text>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.</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
  </level>
</section>
