Residents of Maryland should be aware of state health insurance laws.
The Maryland Insurance Administration (MIA) is an independent agency that is responsible for regulating the state's health insurance industry. MIA's primary functions are to familiarize consumers with Maryland's health insurance rules and to protect them by making sure that insurance companies are acting in accordance with the law. Further information can be obtained by contacting the MIA directly.
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
410-468-2000
mdinsurance.state.md.us
General Information for New Buyers
All Maryland health insurance policies are required to contain a guaranteed renewability provision, which states that a customer's health insurance policy must be renewed so long as that customer has paid her premiums on time. Additionally, if a customer is switching health insurance companies within the state, the new company is permitted by law to impose an exclusionary period. For those with policies that cover dependents, newborn babies and adopted children are automatically covered for up to 31 days. In addition, dependents with disabilities who are over the policy's legal age limit are still permitted to be covered under that policy. Any disagreements or complaints that arise regarding an insurance provider should be filed with the MIA.
Preexisting Conditions and Exclusions
State health insurance policies, such as PPOs, are allowed to include a preexisting condition exclusionary period. However, this period cannot extend for more than two years after the effective date of the policy. In addition, Health Maintenance Organizations (HMOs) are prohibited from imposing any such exclusionary period. In Maryland, preexisting conditions are defined as any medical condition that was treated or diagnosed within the past seven years. Policies are permitted to include elimination riders as well, which permanently exclude coverage for any preexisting medical condition. Customers with these policy riders are responsible for covering 100% of the cost for that condition's medical treatment.
Conversion Policies
Conversion policies are common for Maryland residents who are anticipating a break in their coverage, due to such issues as loss of employment, divorce or death of a spouse. These temporary health insurance policies have no new preexisting condition exclusionary periods, and cannot be canceled just because the policy holder becomes ill. Sometimes, benefits received under a conversion policy will be different than the policy holder's former Maryland health insurance policy, and premiums may also be a bit higher. However, the coverage offered is usually adequate for most individuals, and also fulfills any preexisting condition requirements on subsequent insurance plans.
Maryland Health Insurance Plan
Maryland Health Insurance Plan (MHIP) is a state-managed program that provides health insurance to individuals who are unable to purchase private insurance due to preexisting conditions. People who are guaranteed insurance through MHIP are referred to as HIPAA-eligible; these people may have exhausted all COBRA continuation coverage available to them, or had at least 18 months of continuous creditable coverage, with the last day having been under a group plan. MIA can help determine whether someone is HIPAA-eligible.
Maryland Health Insurance Plan
10455 Mill Run Circle
Mail Stop RR-291
Owings Mills, MD 21117
888-444-9016
marylandhealthinsuranceplan.state.md.us
Tags: health insurance, exclusionary period, Health Insurance Plan, health insurance policies, Insurance Plan
