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31.11.01.00.htm 31.11.01.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 11 HEALTH INSURANCE ― GROUP Chapter 01 Conversion of Group Health Insurance Authority: Insurance Article, §2-109, Annotated Code of Maryland
31.11.01.01.htm 31.11.01.01. 01 Purpose.. The purpose of this chapter is to provide appropriate standards and requirements for implementing the conversion privilege and notification requirements under group health insurance policies.
31.11.01.02.htm 31.11.01.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Carrier" means:. a) An insurer as defined in Insurance Article, §1-101, Annotated Code of Maryland; or. b) A nonprofit health service plan that is licensed to operate in Maryland.. 2) "Converted policy" means an individual policy or certificate issued to an individual in accordance with the requirements of this chapter upon termination of the individual'
31.11.01.03.htm 31.11.01.03. 03 Applicability.. A. This chapter is applicable to group health insurance policies issued or renewed in Maryland on or after October 1, 1983 and prior to January 1, 2014, except as provided in §B―C of this regulation.B. This chapter is not applicable to:. 1) Group policies providing coverage only for:. a) Specified diseases;. b) Accidental injuries;. c) Accidental death;. d) Dental benefits;. e) Vision care or any other supplemental benefit; or.
31.11.01.04.htm 31.11.01.04. 04 Conversion Privilege.. A. All group policies, as defined in this chapter, shall contain a provision stating that an insured person who has been continuously covered under the group policy and under any group policy providing similar benefits which it replaces for at least 3 months and whose coverage is terminated for any reason other than the reasons described in §D of this regulation, shall have issued to him without evidence of insurability a converted policy providi
31.11.01.05.htm 31.11.01.05. 05 Insurer's Option.. A. Instead of issuing an individual converted policy, the carrier may elect to provide the coverage required by this chapter by means of a group policy issued to a trustee and covering persons eligible for the conversion rights of these regulations.B. The policy issued under §A of this regulation may provide that the entire premium be payable by the insured persons.C. The group policy issued under §A of this regulation shall provide benefi
31.11.01.06.htm 31.11.01.06. 06 Standards for Converted Policies.. A. The converted policy shall become effective on the day following the date of termination of insurance coverage under the group policy.B. The converted policy shall cover the employee or member or dependents of the employee or member, or both, who are covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any dependent.C. If a converted policy
31.11.01.07.htm 31.11.01.07. 07 Evidence of Insurability.. A. The converted policy shall be issued without evidence of insurability.. B. If the insured person was individually rated less favorably than standard under the group policy, or if all persons in the group policy were rated less favorably than standard, the converted policy may be issued with a corresponding rating.C. If, by reason of a specific waiver or endorsement in the group policy, the insured person was specifically excluded from c
31.11.01.08.htm 31.11.01.08. 08 Application for Converted Policy.. A. The conversion provision in the group policy may require that the insured person, or a person acting on behalf of the insured person, make written application for the converted policy and may not require that the first premium due to the carrier be paid sooner than 31 days following the termination of the insured person's coverage under the group policy, or sooner than any extended time provided in these regulations.B. The application for th
31.11.01.09.htm 31.11.01.09. 09 Premiums for Converted Policies.. A. Except as provided in §C of this regulation, the initial premium for the converted policy for the first 12 months and subsequent renewal premium shall be determined in accordance with the carrier's premium rates applicable to:1) Individually underwritten standard risks;. 2) The age and class of risk of each individual to be covered under the converted policy; and. 3) The type and amount of coverage provided.. B. The experience under c
31.11.01.10.htm 31.11.01.10. 10 Minimum Benefits under Converted Policies.. A. Except as provided in §B of this regulation, if the group policy from which conversion is made provided coverage for basic hospital, medical, or surgical expense insurance, the insured person at the insured person's option shall be entitled to obtain a converted policy under any one of Plans A, B, or C, which are described in §C of this regulation.B. If the group policy provided hospital benefits based on the full cost of
31.11.01.11.htm 31.11.01.11. 11 Benefit Levels.. If the coverage under the group policy from which conversion is being made provided benefits less than those which would be required in Regulation .10 of this chapter, the carrier, at its option, may provide a converted policy with benefits which are substantially similar to those provided under the group policy instead of offering the plans required in Regulation .10 of this chapter.
31.11.01.12.htm 31.11.01.12. 12 Out-of-State Conversions.. A. A converted policy which is delivered outside of Maryland as a conversion from a group policy issued in Maryland shall be on a form which is permitted to be delivered in the other jurisdiction.B. If the carrier is prohibited by the law of the other jurisdiction from issuing a converted policy by reason of not being licensed in that jurisdiction, the carrier shall provide coverage in accordance with the requirements of these regulations und
31.11.01.13.htm 31.11.01.13. 13 Modified Requirements.. Upon request of a carrier, the Commissioner may grant approval for modification of any of the minimum specifications or other requirements of these regulations upon a showing by the carrier that modification is equitably warranted.
31.11.01.14.htm 31.11.01.14. 14 Notification.. A. The insured person whose coverage under a group policy terminates and who is entitled to make application for a converted policy shall be notified of this right, on or before the date of termination of coverage, but not more than 61 days before.B. An insured person who receives the timely notice of the conversion privilege, as described in §A of this regulation, shall be given the right to apply for the converted policy until at least 45 day
31.11.01.15.htm 31.11.01.15. 15 Amendment of Group Policy.. Any group policy issued in Maryland before the effective date of these regulations and not in conformity with these regulations, shall be amended on the annual renewal date of the group policy to conform to the regulations in this chapter.
31.11.01.9999.htm 31.11.01.9999. Administrative History Effective date: November 1, 1983 (10:14 Md. R. 1261). Regulation .02C adopted effective May 6, 1996 (23:9 Md. R. 670). Regulation .07C amended effective May 6, 1996 (23:9 Md. R. 670). Regulation .11 amended effective May 6, 1996 (23:9 Md. R. 670) ―. Chapter recodified from COMAR 09.30.61 to COMAR 31.11.01 effective September 7, 1998 (25:18 Md. R. 1439) ―Chapter revised effective April 7, 2008 (35:7 Md. R. 752).
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