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31.11.03.00.htm 31.11.03.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 11 HEALTH INSURANCE ― GROUP Chapter 03 Group Health Insurance ― Continuation of Coverage of Surviving Spouses Authority: Insurance Article, §2-109, 14-124(b) 15-407―15-409, and 15-412; Health-General Article, §19-703; Annotated Code of Maryland
31.11.03.01.htm 31.11.03.01. 01 Purpose.. The purpose of this chapter is to provide standards for implementing requirements of the Insurance Article and of Health-General Article, Annotated Code of Maryland, with respect to providing or continuing coverage for certain surviving spouses and dependent children.
31.11.03.02.htm 31.11.03.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Applicable change in status" means the death of the insured.. 2) "Dependent child" means an individual who:. a) Is a child of the insured; and. b) Either was covered under the group contract as a qualified or eligible dependent of the insured immediately preceding the applicable change in status, or was born to a qualified secondary beneficiary after the applicable c
31.11.03.03.htm 31.11.03.03. 03 Applicability.. A. This chapter is 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 certi
31.11.03.04.htm 31.11.03.04. 04 Eligibility.. Beginning with an applicable change in status and until the occurrence of an event described in Regulation .07 of this chapter, the qualified secondary beneficiary shall be entitled to the benefits provided under the group contract.
31.11.03.05.htm 31.11.03.05. 05 Coverage Provided.. A. The coverage provided to a qualified secondary beneficiary shall be identical to the coverage which would have been provided under the group contract for the benefit of the qualified secondary beneficiary if the qualified secondary beneficiary had remained an eligible dependent of the insured employee and there had been no applicable change in status.B. If modifications are made in the employer's group contract, the coverage provided to the qualifie
31.11.03.06.htm 31.11.03.06. 06 Conditions of Coverage.. A. In order to receive the benefits provided under the group contract, a surviving spouse of the insured employee shall elect coverage not later than 45 days after the applicable change in status if a request is made for coverage under the group contract under which the insured employee is covered on the date of the applicable change in status. The coverage shall be retroactive to the applicable change in status.B. The request to the emp
31.11.03.07.htm 31.11.03.07. 07 Termination.. Coverage for a qualified secondary beneficiary will terminate on the earliest of any of the following:A. 18 months after the date of the applicable change in status;. B. The date on which the qualified secondary beneficiary 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:
31.11.03.08.htm 31.11.03.08. 08 Conversion and Continuation ― Repealed..
31.11.03.09.htm 31.11.03.09. 09 Notification Requirements.. A. Each group contract to which these regulations are applicable shall include a statement as provided in §B of this regulation.B. The statement shall disclose the availability of the benefits provided under these regulations and shall provide a summary of the eligibility requirements, the duration, and general description of the benefits.C. Each group contract issued before the effective date of this chapter, to which this chapter is ap
31.11.03.10.htm 31.11.03.10. 10 Election Statement.. The form which a qualified secondary beneficiary shall use to elect coverage under these regulations shall be in language substantially as indicated in this regulation:To _ (name of employer). The employee _ (name of employee). whose Social Security number was _ (number). died on _ (date of death). This is to advise that _. name or names of qualified secondary beneficiaries) . who were covered as qualified dependents of the employee under the employer
31.11.03.11.htm 31.11.03.11. 11 Termination Statement.. The termination statement shall be in language substantially as indicated in this regulation:. To _ (name of employer). This is to advise that _. name or names of qualified secondary beneficiaries) . is/are no longer to be covered under our group health insurance contract effective _ (date). The reason for this termination is _ _ (reason). Date: _ _ Signature of qualified secondary beneficiary.
31.11.03.9999.htm 31.11.03.9999. Administrative History Effective date: December 14, 1987 (14:25 Md. R. 2659) ―. Chapter recodified from COMAR 09.30.83 to COMAR 31.11.03 effective September 7, 1998 (25:18 Md. R. 1439)Regulation .08 repealed effective June 22, 2015 (42:12 Md. R. 764).
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