Md. Code Regs. 31.11.03.06

Current through Register Vol. 51, No. 12, June 14, 2024

Section 31.11.03.06 - 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 employer under §A of this regulation shall be in writing and signed by the qualified secondary beneficiary.

C. Costs to Secondary Beneficiary.

(1) The qualified secondary beneficiary shall pay to the employer the employer's entire cost for the coverage to be provided.

(2) The entire cost to the employer includes the employer's customary contribution as well as the contribution customarily required of an employee if there were no applicable change in status.

(3) The entire cost to the employer may include a reasonable administrative fee not to exceed 2 percent of the amount permitted under §C(2) of this regulation.

(4) If the insurer quotes rates to the employer separately for individual coverage and for dependent coverage, the payment to be made on behalf of the qualified secondary beneficiary shall be the rate quoted for dependents.

(5) If the insurer quotes a family rate which would normally include an employee and eligible dependents, the amount payable on behalf of the qualified secondary beneficiary shall be the difference between the family rate and the rate payable for an individual employee who is not covered for dependents.

D. Due Date of Premium.

(1) Payment to the employer for the cost of the coverage is due and shall be paid on or before the first day of each month for which coverage is to be provided unless the employer agrees in writing to payment at a later date.

(2) At the time of the request referred to in §A of this regulation, payment will be due on the date of request. At the date of the request, the amount of payment due shall be the accumulated charges to cover the period beginning with the effective date of the coverage to be provided to the end of the month in which the request is made.

Md. Code Regs. 31.11.03.06