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More Types of Maryland Health Insurance & Health Plans

B. Small Employer Health Plans - Under state law, certain small employers have the right to purchase the Comprehensive Standard Health Benefit Plan (CSHBP). The CSHBP, which was developed by the Maryland Health Care Commission, is a standardized health benefits plan that has the same benefits and program options from carrier to carrier. To be eligible to participate in the CSHBP, the small employer must show that a majority of eligible employees work in Maryland, and that there are at least 2 but no more than 50 eligible employees at the company who work at least 50 percent of its working days. A nonprofit with 501(c)(3) tax status also qualifies - even if it has only one employee. The Commission designs and monitors the plan so that, on average, the cost does not exceed 10 percent of Maryland's average annual wage.

Employers who subscribe must offer it to any employee who works 30 or more hours, and may choose to purchase additional riders. Employers may also decide whether or not to offer benefits to employees who work less than 30 hours a week. Enrollment in a small employer's health plan is similar to that discussed under the "Group Plan" section above. Although self-employed persons are not eligible to subscribe to CSHBP, by law, a carrier is required to offer a renewal policy to self-employed individuals who work and reside in Maryland, and are currently enrolled in the CSHBP. A small employer health plan may not refuse to insure an employee because of a preexisting condition and it also may not impose a pre-existing exclusion on the coverage. Moreover, the carrier may not charge a higher premium because of an employee's or dependent's health status. However, if the employee joins the health plan after his initial eligibility and not during a regular or special enrollment period, a 12-month waiting period may be imposed. The details of the plan's benefits can be found in A Guide to Purchasing Health Insurance for Small Employers, which is available online, www.mhcc.md.gov or by contacting the Maryland Health Care Commission at:

4160 Patterson Avenue
Baltimore, Maryland 21215
410-764-3460
877-245-1762

You may also request this information from the Maryland Insurance Administration.

C. Individual Health Plans - This is health insurance sold to one person or all the members of one family under one policy. Individual coverage is usually purchased when a person's employer does not offer health insurance or the person wishes to supplement an existing policy. Consumers can purchase individual health insurance directly from a health plan of their choice. Most of the plans that are available to groups are also available to individuals; however, an insurer that sells an individual policy is permitted to refuse to offer you a policy because of your health status. You and your family members must be in very good health to qualify. When you fill out the application, you must be as thorough as possible in answering the questions. If the insurer finds out later that you had a medical condition that you did not tell them about on the application, they can take back the money that they have paid on your behalf, leaving you with unpaid claims.

If you buy your individual plan from an HMO, then your pre-existing condition may not be excluded. However, as discussed above, the HMO may refuse to offer you coverage based on your health status.

D. Maryland Health Insurance Plan (MHIP) - MHIP is Maryland's high-risk insurance pool. Though operated by the state, it is administered by a contracted, third-party vendor. You may be eligible for the MHIP if you have lived in Maryland for six or more months and:

are not eligible for group health coverage, COBRA, the Maryland Medical Assistance or Children's Health Insurance Programs, Medicare or any other government-sponsored health insurance program;
have exhausted all available group coverage;
have, or have been offered, health insurance that provides limited or restricted coverage, or that excludes coverage for a specific medical condition or conditions;
are receiving a federal Trade Readjustment Allowance or unemployment benefits under the Trade Adjustment Assistance program, or receiving pension payments from the Pension Benefit Guaranty Corporation; or
have been refused individual health insurance for medical reasons or have a specified medical condition.

The six-month Maryland residency requirement is waived if you were enrolled in a high-risk pool in another state. Qualified enrollees may choose from four different plan options, including a PPO or a policy with high deductible. The premium varies by the option selected and must be paid for by the enrollee. For more information or to enroll, visit MHIP's web site, www.marylandhealthinsuranceplan.net, or call 888-444-9016.

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