How group coverage works is covered in the national Group Health Insurance guide: master policies, certificates, eligibility, coordination of benefits, and federal COBRA. Maryland adds its own state continuation rights after a job ends, a death or a divorce (Insurance Article §§ 15-407 to 15-409). It also has rules for dependent children and the small group market.

State continuation after leaving a job (§ 15-409)

Who qualifies. An "insured" is a Maryland resident employee covered under the employer's current or predecessor group contract for at least 3 months. Continuation is available when employment ends, other than for cause.

How long. Coverage continues until the earliest of:

• 18 months
• nonpayment
• eligibility for other group coverage
• Medicare entitlement
• voluntary termination
• the employer ending its group plan

Cost. No more than the employer and employee contributions combined, plus a reasonable administrative fee approved by the Commissioner.

Election. The election period lasts at least 45 days from the change in status. The employer sends an election form within 14 days of a request.

Continuation after death or divorce (§§ 15-407, 15-408)

• Death. After a covered employee dies, a surviving spouse who was a dependent for at least 30 days may continue coverage for up to 18 months. The election period is at least 45 days.
• Divorce. Continuation is also available to a spouse after the employee and spouse divorce.
• Children of a deceased spouse (§ 15-404). A member may add dependent children who had been covered under the deceased spouse's plan, without evidence of insurability, within 6 months of the death.

Dependents

• Newborns and adopted children are covered from birth, or from when custody is assumed pending adoption (§ 15-401).
• Disabled children stay covered past the limiting age (§ 15-402).
• Grandchildren in court-ordered custody must be covered on request (§ 15-403).

Small employers

• A small employer averaged 50 or fewer employees in the prior year (§ 15-1201). This definition also applies to the Maryland SHOP Exchange.
• A carrier that offers coverage to a small employer must offer it to all eligible employees and their dependents (§ 15-1210).

Common exam traps

• State continuation requires 3 months of coverage and lasts up to 18 months. The election period is at least 45 days.
• Medicare entitlement or other group coverage ends continuation.
• A surviving spouse needs to have been a dependent for at least 30 days.
• Children from a deceased spouse's plan can be added within 6 months.
• A small employer has 50 or fewer employees.