COMAR 31.10.42 · Chapter 42 Continuity of Health Care Notice

Administrative History Effective date: Regulations .01 — .04 adopted as an emergency provision effective January 1, 2015 (42:1 Md. R. 16); adopted permanently effective April 27, 2015 (42:8 Md. R. 608) Authority Insurance Article, §§ 2-109 (a)( 1 ), 15-140 , and 15-10 D-01, Annotated Code of Maryland and Ch. 159, §3, Acts of 2013

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.01 Scope. This chapter applies to each: A. Receiving carrier that issues or delivers individual or group health benefit plans in Maryland; and B. Receiving managed care organization that enrolls Program recipients in Maryland.

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.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Carrier” means: (a) An insurer authorized to sell health insurance; (b) A nonprofit health service plan; (c) A health maintenance organization; (d) A dental plan organization; or (e) Any other entity providing a plan of health insurance, health benefits, or health services authorized under the Insurance Article of the Annotated Code of Maryland or the Affordable Care Act. (2) “Enrollee” means a: (a) Person entitled to health care benefits from a carrier; or (b) Program recipient who is enrolled in a managed care organization. (3) “Health benefit plan” has the meaning stated in Insurance Article, §15-140, Annotated Code of Maryland . (4) “Managed care organization” means: (a) A certified health maintenance organization that is authorized to receive medical assistance prepaid capitation payments; (b) A corporation that: (i) Is a managed care system that is authorized to receive medical assistance prepaid capitation payments; (ii) Enrolls only Program recipients or individuals or families served under the Maryland Children’s Health Program; and (iii) Is subject to the requirements of Health-General Article, §15-102.4, Annotated Code of Maryland.; or (c) A prepaid dental plan that receives fees to manage dental services. (5) “Program recipient” means an individual who receives benefits under the Maryland Medical Assistance Program. (6) “Receiving carrier” means the carrier that issues the new health benefit plan when an enrollee transitions from another carrier or a managed care organization. (7) “Receiving managed care organization” means the managed care organization that accepts the enrollee when the enrollee transitions from another managed care organization or a carrier. (8) “Relinquishing carrier” means a carrier that issued the prior health benefit plan when an enrollee transitions to a new carrier or a managed care organization. (9) “Relinquishing managed care organization” means a managed care organization in which an enrollee had been enrolled prior to the enrollee’s transition to a new managed care organization or a carrier. (10) “Transitioning enrollee” means an enrollee: (a) Who has an effective date of coverage with a receiving carrier or a receiving managed care organization on or after January 1, 2015, under a contract that is issued or renewed on or after January 1, 2015; and (b) Whose coverage under the receiving carrier or receiving managed care organization began within 1 month of the date coverage terminated under the: (i) Health benefit plan with a relinquishing carrier; or (ii) Relinquishing managed care organization.

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.03 Requirement to Provide Continuity of Health Care Notice. A. A receiving carrier shall send a transitioning enrollee the Continuity of Health Care Notice set forth in Regulation .04A of this chapter : (1) Except as provided in §A(2) of this regulation , within 30 days of the enrollee’s effective date of coverage; and (2) If the enrollee’s coverage is made effective retroactively, within 30 days of the date the receiving carrier is notified of the enrollment. B. A receiving managed care organization shall send a transitioning enrollee the Continuity of Health Care Notice set forth in Regulation .04B of this chapter : (1) Except as provided in §B(2) of this regulation , within 30 days of the enrollee’s effective date of coverage; and (2) If the enrollee’s coverage is made effective retroactively, within 30 days of the date the receiving managed care organization is notified of the enrollment. C. The Continuity of Health Care Notices shall be in the language and format described in Regulation .04 of this chapter in not less than 12-point type.

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.04 Continuity of Health Care Notice. A. The following form is to be used by receiving carriers as the Continuity of Health Care Notice required by Regulation .03A of this chapter . B. The following form is to be used by receiving managed care organizations as the Continuity of Health Care Notice required by Regulation .03B of this chapter .

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FORMS AT END OF CHAPTER

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Attachments 31.10.42.04-forms

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31.10.42.04-forms

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Previous Chapter 41 Assignment of Benefits to Nonpreferred Providers

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Next Chapter 43 Medical Stop-Loss Insurance Disclosure

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