Md. Code Regs. 31.17.03.16

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.17.03.16 - Preexisting Condition Limitations

A. The Board may implement a preexisting condition exclusion for the Plan, which shall be described in the Board's contract with the Plan administrator.

B. If the Board implements a preexisting condition exclusion for the Plan, the preexisting condition exclusion may not apply to:

(1) An eligible individual under the Maryland Health Insurance Portability and Accountability Act as defined in Insurance Article, § 15-1301, Annotated Code of Maryland, if the individual applies for the Plan coverage within 63 days of losing prior coverage;

(2) A newborn child, provided that if an additional premium is required for the child's coverage, the child is enrolled within 31 days after the date of birth;

(3) A newly adopted child, provided that if an additional premium is required for the child's coverage, the child is enrolled within 31 days after the date of adoption; or

(4) An individual who:

(a) Has 3 months of prior creditable coverage;

(b) Is eligible for the tax credit for health insurance costs under §35 of the Internal Revenue Code; and

(c) Applies for the Plan coverage within 63 days after losing prior creditable coverage.

C. If an individual applies for coverage under the Plan within 63 days of losing prior creditable coverage, the period of any preexisting condition exclusion shall be reduced by the period of time the individual was covered under prior creditable coverage.

Md. Code Regs. 31.17.03.16

Regulations .16 adopted as an emergency provision effective April 8, 2003 (30:9 Md. R. 609); emergency text amended effective July 1, 2003 (30:16 Md. R. 1072); adopted permanently effective December 22, 2003 (30:25 Md. R. 1851)