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<section article="gin" article_name="Insurance" number="15-409" title_number="15" title_name="Health Insurance" subtitle_number="4" subtitle_name="Eligibility for Coverage; Continuation and Conversion of Policies">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>“Change in status” means the termination of the insured’s employment other than for cause.</text>
      </level>
      <level label="ii">
        <text>“Change in status” includes:</text>
        <level label="1">
          <text>involuntary termination of the insured’s employment other than for cause; and</text>
        </level>
        <level label="2">
          <text>voluntary termination of the insured’s employment by the insured employee.</text>
        </level>
      </level>
    </level>
    <level label="3">
      <text>“Group contract” means:</text>
      <level label="i">
        <text>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</text>
      </level>
      <level label="ii">
        <text>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.</text>
      </level>
    </level>
    <level label="4">
      <text>“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.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>Each group contract in force on the date of the change in status shall provide continuation coverage in accordance with this section.</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
  </level>
  <level label="c">
    <text>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:</text>
    <level label="1">
      <text>18 months after the date of the change in status;</text>
    </level>
    <level label="2">
      <text>the date on which the insured fails to make timely payment of an amount required under subsection (d)(2) of this section;</text>
    </level>
    <level label="3">
      <text>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;</text>
    </level>
    <level label="4">
      <text>the date on which the insured becomes entitled to benefits under Title XVIII of the Social Security Act;</text>
    </level>
    <level label="5">
      <text>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;</text>
    </level>
    <level label="6">
      <text>the date on which the insured elects to terminate coverage under the group contract; or</text>
    </level>
    <level label="7">
      <text>the date on which the employer ceases to provide benefits to its employees under a group contract.</text>
    </level>
  </level>
  <level label="d">
    <text>Continuation coverage under this section shall:</text>
    <level label="1">
      <text>be provided without evidence of insurability or additional waiting periods;</text>
    </level>
    <level label="2">
      <text>require the insured to pay to the employer an amount that does not exceed:</text>
      <level label="i">
        <text>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</text>
      </level>
      <level label="ii">
        <text>a reasonable administrative fee that is subject to review and approval by the Commissioner;</text>
      </level>
    </level>
    <level label="3">
      <text>allow the payment of the amount specified in item (2) of this subsection in monthly installments if the insured elects to do so;</text>
    </level>
    <level label="4">
      <text>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</text>
    </level>
    <level label="5">
      <text>be available to the spouse and dependent children of the insured if:</text>
      <level label="i">
        <text>the group contract provides benefits for spouses and dependent children; and</text>
      </level>
      <level label="ii">
        <text>the insured’s spouse and dependent children were covered under the group contract before the change in status.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>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.</text>
    </level>
    <level label="2">
      <text>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.</text>
    </level>
    <level label="3">
      <text>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.</text>
    </level>
  </level>
  <level label="f">
    <text>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:</text>
    <level label="1">
      <text>the availability of continuation coverage under this section;</text>
    </level>
    <level label="2">
      <text>a summary of the eligibility for and duration of the continuation coverage; and</text>
    </level>
    <level label="3">
      <text>the procedure for making an election to receive continuation coverage if a change in status occurs.</text>
    </level>
  </level>
  <level label="g">
    <text>The Commissioner shall:</text>
    <level label="1">
      <text>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;</text>
    </level>
    <level label="2">
      <text>prescribe by regulation the form and content of the election notification form; and</text>
    </level>
    <level label="3">
      <text>make election notification forms available to each employer whose employees are covered by a group contract.</text>
    </level>
  </level>
  <level label="h">
    <text>Notice of the availability of continuation coverage under this section shall be provided by:</text>
    <level label="1">
      <text>the employer; and</text>
    </level>
    <level label="2">
      <text>the Secretary of Labor as specified in § 8–805(c) of the Labor and Employment Article.</text>
    </level>
  </level>
  <level label="i">
    <text>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.</text>
  </level>
  <level label="j">
    <text>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:</text>
    <level label="1">
      <text>is made in good faith;</text>
    </level>
    <level label="2">
      <text>is reasonable under the circumstances; and</text>
    </level>
    <level label="3">
      <text>is not the result of a mutual or material mistake of fact.</text>
    </level>
  </level>
  <level label="k">
    <text>This section does not affect or limit the right of an insured to conversion privileges under a group contract.</text>
  </level>
</section>
