2013 Maryland Code
INSURANCE
§ 15-1315 - Plans issued through Individual Exchange [Effective January 1, 2014].


MD Ins Code § 15-1315 (2013) What's This?

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Individual Exchange" has the meaning stated in § 31-101 of this article.

(3) "Qualified health plan" has the meaning stated in § 31-101 of this article.

(4) "Qualified individual" has the meaning stated in § 31-101 of this article.

(b) Scope of section. -- This section applies to a qualified health plan that is issued on or after January 1, 2014, by a carrier through the Individual Exchange.

(c) Grace period provision. -- A qualified health plan subject to this section shall include a grace period provision applicable to a qualified individual who:

(1) is receiving advance payments of federal premium tax credits; and

(2) has paid at least 1 full month's premium during the benefit year.

(d) Scope of grace period. -- The grace period provision shall:

(1) provide a grace period of 3 consecutive months; and

(2) be in addition to any other grace period provision required by any other applicable State law.

(e) Duties of carrier during grace period. -- During the grace period, a carrier that issues a qualified health plan subject to this section:

(1) shall pay all appropriate claims for services rendered to the qualified individual during the first month of the grace period;

(2) may pend claims for services rendered to the qualified individual in the second and third months of the grace period;

(3) shall notify the federal Department of Health and Human Services that the qualified individual is in the grace period; and

(4) shall notify providers of the possibility that claims may be denied when a qualified individual is in the second and third months of the grace period.

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