Maryland Health Insurance (MD)

Maryland (MD)
Individual Health Insurance Regulations

Learn more about Maryland Individual Health Insurance

Health insurance is the best solution when it comes to securing your family's physical well-being. In the event of unforeseen circumstances, suitable health coverage can save you from unexpected medical bills. Shopping for a health insurance policy is tedious and needs evaluation of family's medical needs and finances. If you are a Maryland resident, you can choose from wide range of health insurance alternatives. The Maryland Insurance Administration regulates the laws under which the Maryland health insurers can sell private health insurance to individuals and families.

When applying for individual health insurance in Maryland, the health insurance carrier has the right to request that they be provided with 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 84-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. Premium rates vary from one insurer to another and are based upon plan type, age, health status and gender.

Maryland (MD)

Small Group Health Insurance Regulations

Small group health insurance is available to companies with 2-50 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.

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.

Title 31 of the Maryland Insurance Administration, Chapter 4 addresses Continuation of Coverage for Terminated Employees addresses the mini-cobra law of Maryland. The state 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. Employees have at least 45 days from termination date to elect continuation of coverage. 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.

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