Maryland Health Insurance (MD)

Maryland (MD)
Individual Health Insurance Regulations

Learn more about Maryland Individual Health Insurance

When applying for individual health insurance in Maryland, the health insurance carrier has the right to request that they be provided specific medical information concerning past and present health history. Based upon the information provided during the application process, the health insurance carrier may decline to offer health insurance coverage or may offer coverage with specific limitations or exclusions placed on the policy. By law, Elimination Riders are permitted and may amend your policy to exclude coverage for specific health conditions, body parts or body systems. Although HMOs may not impose a pre-existing exclusion period, there is a 4 month look back and 24 month exclusionary period limit for pre-existing conditions on all other individual health insurance policies. Credit for prior coverage must only be given to those individuals exercising their group-to-individual portability rights under HIPAA.

Maryland (MD)
Small Group Health Insurance Regulations

Small group health insurance is available to companies with 1-50 employees. Under Maryland state law, small group health insurance must be offered on a guarantee issue basis. Guarantee issue coverage provides that each eligible employee who is offered health insurance may not be declined coverage due to current or past health history. Your employer may impose a waiting period from the date of hire prior to allowing you to become eligible to join the group plan. Waiting periods must be the same for all employees working for the company. Health insurance carriers, under Maryland law, are not permitted any look back or impose exclusionary periods on pre-existing medical conditions. Premium rates for small group health insurance are geographically and age based with a rate adjustment factor 40 percent. Self employed groups of one must also be provided coverage on a guarantee issue basis, but guaranteed acceptance is limited to an annual enrollment period.

Maryland COBRA and Continuation Coverage

Under both federal and state law, continuation of health insurance coverage must be provided to those individuals who have lost their group health insurance coverage due to a qualifying event. Under COBRA you may remain on the employer-sponsored health plan, receiving the same level of coverage, for a period of 18 months. You will be responsible for paying 100 % of the monthly premium, plus a 2 % administration fee. Election of COBRA benefits must be done in writing within 45 days of termination. Federal COBRA applies to companies with 20 or more employees and Maryland mini-COBRA laws apply to companies with fewer than 20 employees. To qualify for mini-COBRA, an employee must have been covered under the group health plan for at least 3 months. Continuation coverage is available through conversion plans for those that exhaust their COBRA. The Maryland Health Insurance Plan provides an alternative option of guaranteed coverage for person that have exhausted their COBRA and are ineligible for a standard individual medical insurance policy due to pre-existing medical conditions.

Maryland Continuation law determines the length of continuation coverage be based on the reason why the employee has left the group health plan. If an employee is terminated without cause, they must be offered 18 months of continuation coverage. All other employees are offered 6 months of continuation coverage if they were insured under the group health plan for at least 3 months.

Additional Maryland Resources

• Maryland Health Insurance Plan (MHIP)
  MHIP is a state administered health insurance program for Maryland residents who do not have access to health insurance.
• Maryland Children's Health Program (MCHP)
  MCHP is a state run program offering full health benefits for children up to the age of 19 and pregnant women of any age who meet the income guidelines.
• Maryland Medical Assistance
  The Maryland Medical Assistance Program is the state's Medicaid program that provides medical insurance and health care solutions for low-income residents.
• Maryland Department of Aging
  Provides Medicare related information, education, programs and services to the senior population of Maryland.

MD Medical Insurance Statistics

Total Population: 5,569,000
With Health Insurance: 4,781,000 / 85.8%
Without Health Insurance: 788,000 / 14.2%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Maryland residents without health insurance has decreased by .4% since 2004.

Maryland Insurance Administration
Phone: 800-492-6116
The Maryland Insurance Administration is the state agency that regulates the insurance industry and protects consumers from unethical practices of insurance companies and agents.

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