Posted on Fri, Oct 16, 2009
Understanding the ins and outs of Maryland individual health insurance regulations can be confusing, but it is important to arm yourself with information when searching for right coverage to meet your needs. When you submit your application for health insurance, know that the insurer has certain rights in regards to your application that can significantly impact your coverage and premiums.
Below are some of the ways the health insurance provider may respond to your request for coverage:
- Any Maryland health insurance company may request information about the applicant's medical history, including any medical conditions.
- The insurer has the right to decline coverage based upon the personal information you provide in the application.
- The insurer may offer a plan with specific limitations or exclusions on certain medical conditions.
- Maryland law allows elimination riders, which allow the insurer to adjust any policy to exclude coverage for health conditions, or even body parts.
- When evaluating the applicant for all health plans, except when the selected plan is an HMO, insurers may review the applicant's health history up to 4 months prior to the application. An insurance carrier in Maryland may impose an exclusionary period for pre-existing conditions coverage for a maximum of 24 months. (HMO plans are not allowed to impose an exclusionary period for pre-existing conditions.)
- Insurers must provide credit to applicants who have had prior continuous coverage and are exercising their rights under the Group-to-Individual Portability Act through HIPPA.
Maryland Small Group Health Insurance Regulations
Any Maryland employer group with one to 50 employees qualifies for small group health insurance. Maryland law states that insurers must offer health coverage for small groups on a guarantee issue basis, meaning each eligible employee who is offered health insurance by the employer may not be declined coverage in the future.
An employer has the right to impose a waiting period beginning at the hire date before the employee becomes eligible for coverage under the small group plan, but the waiting period is required to be the same for all employees working for one company. Maryland state law states that insurers are not permitted to review medical history or impose an exclusion period for any pre-existing conditions.
Insurers determine the premium rates for Maryland small group health insurance based on geography and age and have a rate adjustment factor of 40%. Additionally, self-employed individuals can qualify as a "small group" and are eligible for small group coverage on the same guarantee basis; acceptance for self-employed individuals is reviewed annual during the period of enrollment.
Understanding Maryland COBRA and Continuation Coverage Issues
Federal law and Maryland state law require insurers to provide individuals, who have lost group health insurance due to a qualifying event, with continuation of health coverage. The COBRA plan states that one can remain under the employer-sponsored coverage, receiving all the benefits, for up to 18 months. The individual is responsible for paying all of the monthly premiums in addition to a 2% fee for administration.
Employees have 45 days from the time of termination to choose COBRA benefits, by requesting the coverage in writing. There are two different COBRA options available:
- Federal COBRA-companies with 20 or more employees qualify.
- Mini-COBRA-companies with fewer than 20 employees qualify. To apply for mini-COBRA, an employee must have received coverage under the small group health plan for a minimum of three months.
Conversion plans are also available to provide continuation coverage for people who surpass the 18 months on COBRA. People ineligible for a standard medical plan because of pre-existing medical conditions and who have run out of time with COBRA can qualify for the continuation coverage.
According to Maryland Continuation Law, the length of this continuation coverage varies depending on the reason why the employee left the small group health plan. An employee who was terminated without a reasonable cause is eligible for 18 months of coverage, while other terminated employees can receive 6 months of coverage, as long as they were covered for at least three months through the small group health plan.
Maryland medical insurance quotes