Md. Code Regs. 31.17.03.17

Current through Register Vol. 51, No. 21, October 18, 2024

Section 31.17.03.17 - Termination of Coverage

A. Termination of Plan Coverage for Nonpayment of Premium. A member's coverage automatically terminates at the end of the grace period if a premium is not received before the end of the grace period.

B. Termination of Plan Coverage for Specified Causes.

(1) A member's coverage under the Plan terminates at the end of the month in which any of the following occur:

(a) For a dependent child, other than a child who is unable to self support due to physical or mental incapacity, when the dependent child reaches the limiting age found in the member's certificate of coverage; or

(b) The member ceases to be a resident of the State.

(2) A member's coverage shall terminate under the Plan if:

(a) The member or the member's covered dependent has performed an act or practice that constitutes fraud;

(b) The member has made an intentional misrepresentation of material fact in the application for Plan coverage;

(c) The member becomes covered under other coverage that is substantially similar to the coverage of the Plan;

(d) The member becomes eligible for employer sponsored coverage that includes benefits comparable to Plan benefits, unless the member is eligible for the tax credit for health insurance costs under §35 of the Internal Revenue Code; or

(e) The member becomes eligible for coverage under Medicare, the Maryland Medical Assistance Program, or the Maryland Children's Health Program.

(3) If a member's coverage terminates for one of the reasons described in §B(2)(a)-(e) of this regulation, coverage for the member and any of the member's dependents ends following notice from the Plan administrator on the following dates:

(a) If the Plan administrator gives notice of termination before the 15th day of a month, at the end of that month; or

(b) If the Plan administrator gives notice of termination on or after the 15th day of a month, at the end of the following month.

C. Termination for Moving Out of the Service Area.

(1) If the Board selects a health maintenance organization to be one of the standard benefit packages offered under the Plan, a member's coverage under the Plan terminates at the end of the month when the member moves out of the service area of the health maintenance organization.

(2) If a member's coverage under the Plan terminates for the reason described in §C(1) of this regulation, the member shall be given an option to enroll immediately into one of the other standard benefit packages offered by the Plan, if the member continues to reside within the State.

Md. Code Regs. 31.17.03.17

Regulations .17 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)