PARRIS N. GLENDENING, Governor

Ch. 35

Defined terms: "Alzheimer's disease" § 18-101
"Long-term care insurance" § 18-101
"Preexisting condition" § 18-101

18-112. CONTINUATION OF COVERAGE OR CONVERSION OF POLICIES.

(A) IN GENERAL.

EACH GROUP POLICY OF LONG-TERM CARE INSURANCE SHALL PROVIDE
COVERED INDIVIDUALS WITH A BASIS FOR CONTINUATION OF COVERAGE OR
CONVERSION TO AN INDIVIDUAL POLICY OF LONG-TERM CARE INSURANCE.

(B) BASIS FOR CONTINUATION OF COVERAGE.

(1) FOR PURPOSES OF THIS SECTION, A GROUP POLICY OF LONG-TERM
CARE INSURANCE PROVIDES A BASIS FOR CONTINUATION OF COVERAGE IF THE
GROUP POLICY:

(I) MAINTAINS COVERAGE UNDER THE EXISTING GROUP POLICY
WHEN THE COVERAGE WOULD OTHERWISE TERMINATE; AND

(II) IS SUBJECT ONLY TO THE CONTINUED TIMELY PAYMENT OF

PREMIUMS.

(2) A GROUP POLICY THAT RESTRICTS BENEFITS AND SERVICES TO
CERTAIN PROVIDERS OR FACILITIES OR CONTAINS INCENTIVES TO USE CERTAIN
PROVIDERS OR FACILITIES MAY PROVIDE CONTINUATION BENEFITS THAT ARE
SUBSTANTIALLY EQUIVALENT TO THE BENEFITS OF THE EXISTING GROUP POLICY.

(C) BASIS FOR CONVERSION OF COVERAGE.

FOR PURPOSES OF THIS SECTION, A GROUP POLICY PROVIDES A BASIS FOR
CONVERSION OF COVERAGE IF THE GROUP POLICY PROVIDES FOR ISSUANCE OF A
POLICY THAT PROVIDES BENEFITS THAT ARE IDENTICAL TO, SUBSTANTIALLY
EQUIVALENT TO, OR IN EXCESS OF THE BENEFITS OF THE TERMINATED GROUP
POLICY WITHOUT EVIDENCE OF INSURABILITY TO EACH INDIVIDUAL:

(1) WHOSE COVERAGE UNDER THE GROUP POLICY WOULD OTHERWISE
BE TERMINATED FOR ANY REASON; AND

(2) WHO HAS BEEN CONTINUOUSLY INSURED UNDER THE GROUP
POLICY FOR AT LEAST 6 MONTHS BEFORE THE DATE OF TERMINATION.

(D) DETERMINATION OF SUBSTANTIALLY EQUIVALENT BENEFITS.

IN DETERMINING WHETHER BENEFITS ARE SUBSTANTIALLY EQUIVALENT
UNDER THIS SECTION, THE COMMISSIONER SHALL CONSIDER THE DIFFERENCE
BETWEEN MANAGED CARE PLANS AND OTHER PLANS.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 645.1(a) through (d).

In subsection (a) of this section, the reference to an individual policy of

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