Md. Code Regs. 17.04.13.04

Current through Register Vol. 51, No. 24, December 2, 2024

Section 17.04.13.04 - Effective Dates for Eligible Persons

A. Eligibility. Generally, each employee is eligible for coverage on the first scheduled working day. Each retired employee is eligible for coverage on the first day of retirement or the first day of election in accordance with §B(1)(a) of this regulation. Dependents of covered employees or retired employees are eligible on the date the employee or retired employee becomes eligible. Later acquired dependents become eligible on the date they become dependents of a covered employee or retired employee. Eligibility for the State subsidy may come at a date separate from and subsequent to eligibility for coverage in general.

B. Coverage.

(1) Eligible Employees Listed in Regulation .03A(1)-(8) of this Chapter.

(a) An eligible employee or retired employee shall apply for coverage for himself and eligible dependents within 60 days of the employment or retirement date by submitting to the appointing authority an application and payroll deduction authorization form for the coverage desired or shall wait for the annual open enrollment period unless otherwise indicated in §C of this regulation. The Salary Reduction Agreement may be combined with the electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system. Coverage shall be effective in accordance with Eligibility Provisions. Coverage is purchased pretax on a prospective basis only in accordance with the State cafeteria plan adopted by the Department of Budget and Management in accordance with federal tax law. Employees will receive invoices for all outstanding coverage fees which are not satisfied through a payroll deduction; these amounts will not be on a pretax basis.

(b) Coverage for later acquired or newly eligible dependents of a covered employee or retired employee is obtained by submitting, in the case of an active employee, an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system or, in the case of a retired employee, an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system or an application to the Department of Budget and Management, within 60 days of the change in status. Coverage shall be effective in accordance with Eligibility Provisions. Coverage is purchased pretax on a prospective basis only in accordance with the State cafeteria plan adopted by the Department of Budget and Management in accordance with federal tax law. Employees will receive invoices for all outstanding coverage fees which are not satisfied through a payroll deduction; these amounts will not be on a pretax basis.

(c) A newborn child may be covered from birth when maternity benefits are provided. However, the employee shall make application within 60 days from the date of the child's birth to convert to an appropriate membership to provide coverage for the newborn child. Coverage for the newborn shall be effective on the date of birth provided the employee submits an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system within 60 days of the date of birth. Coverage is purchased pre-tax on a prospective basis only in accordance with the State cafeteria plan adopted by the Department of Budget and Management in accordance with federal tax law.

(2) Contractual Employees Working More than 30 Hours per Week or 130 Hours per Month.

(a) An eligible contractual employee working more than 30 hours per week, or an average of 130 hours per month, as determined after any necessary measurement period, shall apply for coverage for himself and eligible dependents within 60 days of eligibility by submitting an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system for the coverage desired, or shall wait for the annual open enrollment period unless otherwise indicated in §C of this regulation. The eligible contractual employee working more than 30 hours per week, or an average of 130 hours per month, shall be provided a State subsidy equal to 75 percent of the premium for elected medical and prescription drug coverage. The employee shall pay 25 percent of the total cost of the premium in accordance with the direct billing procedures of the Department of Budget and Management. For all other coverage elected, the employee shall pay the total cost of the premium in accordance with the direct billing procedures of the Department of Budget and Management and may not receive a State subsidy. Coverage shall be effective in accordance with Eligibility Provisions.

(b) Coverage for later acquired or newly eligible dependents of a covered contractual employee is obtained by submitting an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system within 60 days of the change in status. Coverage for that dependent shall be effective in accordance with Eligibility Provisions.

(c) A newborn child may be covered from birth when maternity benefits are provided. However, the employee shall make application within 60 days from the date of the child's birth to convert to an appropriate membership to provide coverage for the newborn child. Coverage for the newborn shall be effective as of the child's date of birth provided the employee submits an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system within 60 days of the date of birth.

(3) Permanent Employees Working Less than 50 Percent of the Workweek and Contractual Employees Working Less than 30 Hours per Week.

(a) An eligible permanent employee working less than 50 percent of the workweek or contractual employee working less than 30 hours per week or 130 hours per month may apply for coverage for the employee and eligible dependents within 60 days of employment by submitting an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system for the coverage desired, or shall wait for the annual open enrollment period. Such employees shall pay the total cost of the premium in accordance with the direct billing procedures of the Department of Budget and Management and may not receive a State subsidy. Coverage shall be effective in accordance with Eligibility Provisions.

(b) An eligible permanent employee working less than 50 percent of the workweek or contractual employee working less than 30 hours per week or 130 hours per month may obtain coverage for later acquired or newly eligible dependents by submitting an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system for the coverage desired within 60 days of the qualifying event, or shall wait for the annual open enrollment period. Coverage for that dependent shall be in accordance with Eligibility Provisions.

(c) A newborn child may be covered from birth when maternity benefits are provided. However, the employee shall make application within 60 days from the date of the child's birth to convert to an appropriate membership to provide coverage for the newborn child. Coverage for the newborn shall be effective as of the date of birth provided the employee submits an electronic enrollment form completed by the employee (or the employee's representative) using the State's selected human capital management system.

C. Permissible Changes in Coverage.

(1) Except as provided in §C(2) of this regulation, changes in coverage outside of Open Enrollment may be made only if and when those changes are permissible in a cafeteria plan governed by 26 U.S.C. § 125 and 26 CFR §§ 1.125-1-1.125-7.

(2) Changes in coverage for eligible dependents who are covered on a post-tax basis are permissible if and when such changes are consistent with the requirements of §C(1) of this regulation. In determining whether the requested change is consistent, the eligible dependent shall be treated as if the coverage is provided on a pre-tax basis.

Md. Code Regs. 17.04.13.04

Regulation .04 repealed and new Regulation .04 adopted as an emergency provision effective July 1, 2008 (35:15 Md. R. 1346); adopted permanently effective August 25, 2008 (35:17 Md. R. 1489)
Regulation .04B, C amended effective July 1, 2009 (36:10 Md. R. 717)
Regulation .04 amended effective 42:3 Md. R. 317, eff.2/16/2015; amended effective 49:23 Md. R. 997, eff. 11/14/2022