Plans issued through Individual Exchange

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    (a)    (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.


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