PARRIS N. GLENDENING, Governor                                S.B. 843

(D) A CARRIER SHALL ALLOW AN EMPLOYEE OR DEPENDENT WHO IS
ELIGIBLE, BUT NOT ENROLLED, FOR COVERAGE UNDER THE TERMS OF A GROUP
HEALTH BENEFITS PLAN TO ENROLL FOR COVERAGE UNDER THE TERMS OF THE
PLAN IF:

(1) THE EMPLOYEE OR DEPENDENT WAS COVERED UNDER AN
EMPLOYER-SPONSORED PLAN OR GROUP HEALTH BENEFITS PLAN AT THE TIME
COVERAGE WAS PREVIOUSLY OFFERED TO THE EMPLOYEE OR DEPENDENT;

(2) THE EMPLOYEE STATES IN WRITING. AT THE TIME COVERAGE WAS
PREVIOUSLY OFFERED. THAT COVERAGE UNDER AN EMPLOYER-SPONSORED PLAN
OR GROUP HEALTH BENEFITS PLAN WAS THE REASON FOR DECLINING
ENROLLMENT. BUT ONLY IF THE PLAN SPONSOR OR ISSUER REQUIRES THE
STATEMENT AND PROVIDES THE EMPLOYEE WITH NOTICE OF THE REQUIREMENT;
AND

(3) THE EMPLOYEE'S OR DEPENDENTS COVERAGE DESCRIBED IN ITEM
(1) OF THIS SUBSECTION:

(I) WAS UNDER A COBRA CONTINUATION PROVISION, AND THE
COVERAGE UNDER THAT PROVISION WAS EXHAUSTED; OR

(II) WAS NOT UNDER A COBRA CONTINUATION PROVISION, AND
EITHER THE COVERAGE WAS TERMINATED AS A RESULT OF LOSS OF ELIGIBILITY
FOR THE COVERAGE. INCLUDING LOSS OF ELIGIBILITY AS A RESULT OF LEGAL
SEPARATION, DIVORCE. DEATH. TERMINATION OF EMPLOYMENT. OR REDUCTION
IN THE NUMBER OF HOURS OF EMPLOYMENT OR EMPLOYER CONTRIBUTIONS
TOWARDS THE COVERAGE WERE TERMINATED.

15-1407.

A CARRIER MAY NOT REQUIRE AN INDIVIDUAL MEMBER OF A GROUP TO PAY
A PREMIUM OR CONTRIBUTION THAT IS GREATER THAN THE PREMIUM OR
CONTRIBUTION FOR A SIMILARLY SITUATED INDIVIDUAL, BASED ON ANY HEALTH
STATUS-RELATED FACTOR.

15-1408.

A CARRIER SHALL RENEW GROUP HEALTH BENEFIT PLANS AT THE OPTION OF
THE POLICYHOLDER OR PLAN SPONSOR, EXCEPT IN ANY OF THE FOLLOWING CASES:

(1)      FOR NONPAYMENT OF THE REQUIRED PREMIUM;

(2)      WHERE THE POLICYHOLDER OR PLAN SPONSOR HAS PERFORMED
AN ACT OR PRACTICE THAT CONSTITUTES FRAUD;

(3)      WHERE THE POLICYHOLDER OR PLAN SPONSOR HAS MADE AN
INTENTIONAL MISREPRESENTATION OF MATERIAL FACT UNDER THE TERMS OF THE
COVERAGE;

(4)      WHERE THE POLICYHOLDER OR PLAN SPONSOR HAS FAILED TO
COMPLY WITH A MATERIAL PLAN PROVISION RELATING THE EMPLOYER
CONTRIBUTIONS OR GROUP PARTICIPATION RULES;

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