§ 15-1315
295 words·~1 min read·
/md/insurance/15-1315A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1315.
(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)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)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)fails to pay premiums timely.
(d)The grace period provision shall:
(1)provide a grace period of 3 consecutive months after the initial premium payment to begin coverage has been paid;
(2)apply to qualified health plans renewed in accordance with § 15–1309 of this subtitle without the qualified individual having to pay the first month’s premium following renewal; and
(3)be in addition to any other grace period provision required by any other applicable State law.
(e)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.