Chapter 04. Group Health Insurance — Continuation of Coverage for Terminated Employees

In this chapter, the following terms have the meanings indicated.

Terms Defined.

These regulations shall be applicable to all group health insurance policies or contracts issued or delivered in this State to the employer of the insured which provide hospital, surgical, medical, or major medical benefits on an expense-incurred basis whether issued by a nonprofit health service plan or by any other insurer and to all group policies or contracts issued or delivered in this State to an employer by a health maintenance organization certified under Health-General Article, Title 19, Subtitle 7, Annotated Code of Maryland.

These regulations shall be applicable to any policy or contract issued on or after the effective date of these regulations, beginning with the date of issue of the policy or contract.

These regulations shall be applicable to any policy or contract issued before the effective date of these regulations, beginning on the first annual renewal date or the first anniversary of the date of issue of the policy or contract occurring on or next following the effective date of this chapter.

The coverage provided shall be identical to the coverage offered under the group contract to similarly situated individuals for whom there has been no applicable change in status.

If the group policy provides benefits for spouses and dependent children, the coverage provided shall be available to the insured's:

If the employer transfers from one group contract to another, the coverage provided the insured will be transferred to that coverage provided under the new group contract.

If the employer provides various hospital, surgical, medical, or major medical coverages under one or more group contracts, an insured may not elect to choose less than all of the benefits provided unless the insured would have had the option of making such a choice if there had been no applicable change in status.

The benefits to be provided under the group contract shall be in no respect less favorable than those required by these regulations.

In order to receive the benefits provided under the group contract, an insured shall elect coverage not later than 45 days after the applicable change in status.

The coverage shall be retroactive to the applicable change in status.

The request to the employer under §A of this regulation shall be in writing and signed by the insured.

Continuation coverage shall be provided without evidence of insurability or additional waiting periods.

Costs to Insured.

The insured may elect to pay the employer the amount due for the cost of the coverage in monthly installments.

In addition to the allowable cost provided for under §E of this regulation, the first payment to the employer by the insured shall include the cost for the coverage provided after the change in status and until the end of the month in which the insured makes an election.

18 months after the date of the applicable change in status;

The date on which the insured becomes eligible for hospital, surgical, medical, or major medical benefits under any insured group contract or any health maintenance organization group contract or any self-insured group health benefit program or plan provided:

The date on which the insured becomes entitled to benefits under Title XVIII of the Social Security Act;

The date on which the insured becomes covered under a non-group policy or under a non-group health maintenance organization contract which provides coverage for hospital, surgical, medical, or major medical benefits on an expense-incurred basis;

The premium due date on which the insured does not make timely payment in the amount required for the provided coverage;

The date on which the insured elects not to be covered under the group contract;

The date on which the employer ceases to provide hospital, surgical, medical, or major medical benefits to its employees under a group contract.

Every group contract to which this chapter is applicable shall include a statement as provided in §B of this regulation.

The statement shall disclose the availability of the benefits provided under this chapter and shall provide a summary of the eligibility requirements, the duration, and general description of the benefits.

Every group contract issued before the effective date of this chapter, to which this chapter is applicable, shall be amended in accordance with this chapter not later than the date of applicability stated in Regulation .03C of this chapter.