Search
Bill number does not exist. Enter a vaild keyword.

Statutes Text

Article - Insurance




§15–1208.2.

    (a)    (1)    In this section the following words have the meanings indicated.

        (2)    “Dependent” means an individual who is or who may become eligible for coverage under the terms of a health benefit plan because of a relationship with an eligible employee.

        (3)    “Qualifying coverage in an eligible employer–sponsored plan” has the meaning stated in 45 C.F.R. § 155.300.

    (b)    (1)    A carrier shall establish a standardized annual open enrollment period of at least 30 days for each small employer.

        (2)    The annual open enrollment period shall occur before the end of the small employer’s plan year.

        (3)    During the annual open enrollment period, each eligible employee of the small employer shall be permitted to:

            (i)    enroll in a health benefit plan offered by the small employer;

            (ii)    discontinue enrollment in a health benefit plan offered by the small employer; or

            (iii)    change enrollment from one health benefit plan offered by the small employer to a different health benefit plan offered by the small employer.

    (c)    A carrier shall provide an open enrollment period of at least 30 days for each employee who becomes an eligible employee outside the initial or annual open enrollment period.

    (d)    (1)    A carrier shall provide an open enrollment period for each individual who experiences a triggering event described in paragraph (4) of this subsection.

        (2)    The open enrollment period shall be for at least 30 days, beginning on the date of the triggering event.

        (3)    During the open enrollment period for an individual who experiences a triggering event, a carrier shall permit the individual to enroll in or change from one health benefit plan offered by the small employer to another health benefit plan offered by the small employer.

        (4)    A triggering event occurs when:

            (i)    subject to paragraph (5) of this subsection, an eligible employee or dependent loses minimum essential coverage;

            (ii)    an eligible employee or a dependent loses:

                1.    pregnancy–related coverage described under § 1902(a)(10)(A)(i)(IV) and (a)(10)(A)(ii)(IX) of the Social Security Act, which is considered to occur on the last day the eligible employee or dependent would have pregnancy–related coverage; or

                2.    access to health care services through a program providing prenatal care or services, which is considered to occur on the last day the eligible employee or dependent would have access to health care services;

            (iii)    an eligible employee or a dependent loses medically needy coverage as described under § 1902(a)(10)(C) of the Social Security Act, which is considered to occur on the last day the eligible employee or dependent would have medically needy coverage;

            (iv)    an eligible employee or a dependent who is enrolled in a qualified health plan in the SHOP Exchange adequately demonstrates to the SHOP Exchange that the qualified health plan in which the eligible employee or a dependent is enrolled substantially violated a material provision of the qualified health plan’s contract in relation to the eligible employee or a dependent;

            (v)    an eligible employee or a dependent:

                1.    loses eligibility for coverage under a Medicaid plan under Title XIX of the Social Security Act or a state child health plan under Title XXI of the Social Security Act; or

                2.    becomes eligible for assistance, with respect to coverage under the SHOP Exchange, under a Medicaid plan or state child health plan, including any waiver or demonstration project conducted under or in relation to a Medicaid plan or a state child health plan;

            (vi)    for SHOP Exchange health benefit plans:

                1.    an eligible employee’s or a dependent’s enrollment or nonenrollment in a qualified health plan is, as evaluated and determined by the Exchange:

                A.    unintentional, inadvertent, or erroneous; and

                B.    the result of the error, misrepresentation, misconduct, or inaction of an officer, employee, or agent of the Exchange or the federal Department of Health and Human Services, or its instrumentalities, or a non–Exchange entity providing enrollment assistance or conducting enrollment activities;

                2.    an eligible employee is an Indian as defined in § 4 of the federal Indian Health Care Improvement Act;

                3.    an eligible employee or dependent adequately demonstrates to the Exchange that a material error related to plan benefits, service area, or premium influenced the eligible employee’s or dependent’s decision to purchase a qualified health plan through the Exchange; or

                4.    an eligible employee or dependent demonstrates to the SHOP Exchange, in accordance with guidelines issued by the federal Department of Health and Human Services, that the eligible employee or a dependent meets other exceptional circumstances as the SHOP Exchange may provide;

            (vii)    an eligible employee or dependent:

                1.    is a victim of domestic abuse or spousal abandonment, as defined by 26 C.F.R. § 1.36B–2T;

                2.    is enrolled in minimum essential coverage; and

                3.    seeks to enroll in coverage separate from the perpetrator of the abuse or abandonment;

            (viii)    an eligible employee or dependent:

                1.    applies for coverage through the Individual Exchange during the annual open enrollment period or a special enrollment period;

                2.    is assessed by the Individual Exchange as potentially eligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program; and

                3.    is determined ineligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program by the Maryland Department of Health either:

                A.    after open enrollment has ended; or

                B.    more than 60 days after the qualifying event;

            (ix)    an eligible employee or dependent:

                1.    applies for coverage through the Maryland Medical Assistance Program or the Maryland Children’s Health Program during the annual open enrollment period; and

                2.    is determined ineligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program after open enrollment has ended; or

            (x)    an eligible employee or dependent gains access to new qualified health plans as a result of a permanent move and either:

                1.    had minimum essential coverage as described in 26 C.F.R. § 1.5000a–1(b) for 1 or more days during the 60 days before the date of the permanent move;

                2.    lived in a foreign country or in a United States territory for 1 or more days during the 60 days before the date of the permanent move; or

                3.    lived in a service area where no qualified health plan was available through the Exchange:

                A.    for 1 or more days during the 60 days before the date of the permanent move; or

                B.    during the eligible employee’s or dependent’s most recent preceding open enrollment period or special enrollment period.

        (5)    Loss of minimum essential coverage under paragraph (4)(i) of this subsection does not include loss of coverage due to:

            (i)    voluntary termination of coverage;

            (ii)    failure to pay premiums on a timely basis, including COBRA premiums prior to expiration of COBRA coverage; or

            (iii)    a rescission authorized under 45 C.F.R. § 147.128.

        (6)    The triggering event described in paragraph (4)(iii) of this subsection is permitted only once per year per individual.

        (7)    If an eligible employee or a dependent meets the requirements for the triggering event described in paragraph (4)(vi)1 of this subsection, the Exchange may take any action necessary to correct or eliminate the effects of the error, misrepresentation, or inaction.

        (8)    If an eligible employee meets the requirements for the triggering event described in paragraph (4)(vi)2 of this subsection, the eligible employee and a dependent may enroll in a qualified health plan or change from one qualified health plan to another one time per month.

        (9)    An eligible employee or a dependent who meets the requirements for the triggering event described in paragraph (4)(v) of this subsection shall have 60 days from the triggering event to select a health benefit plan.

        (10)    If a victim of domestic abuse or spousal abandonment meets the requirements for the triggering event described in paragraph (4)(vii) of this subsection, the victim’s dependents may enroll in a qualified health plan at the same time as the victim.

    (e)    If an individual enrolls for coverage during one of the open enrollment periods described in this section, coverage shall be effective in accordance with the requirements in 45 C.F.R. § 155.420.