Maryland PDF Forms
Homepage ⇨ Maryland Continuation Election PDF Template
Outline

In Maryland, individuals have the opportunity to continue their employer-sponsored benefit plans after experiencing certain life events, thanks to the Maryland Continuation Election form. This form serves as a request to retain coverage under the Employee Benefit Plan, emphasizing the importance of continuity in healthcare and other benefits in times of transition. Applicants must acknowledge their understanding of the Maryland Continuation Coverage Notice, which outlines their rights and the limitations of these rights. Decisions regarding continuation are pivotal, requiring a clear affirmation of intent to continue coverage, or not, as indicated on the form. Essential details such as the effective date of the continuation coverage, the obligation to include the first payment for coverage to activate, and the specific qualifying event triggering the need for continued coverage—such as termination of employment, death, or divorce—are critical components. Additionally, individuals must specify the type of insurance—health, dental, or vision—and the coverage scale, whether individual, husband/wife, parent/child, or family, recognizing that changes to these selections are typically restricted to open enrollment periods or qualified changes in family status. The form also necessitates the input of personal identification and contact information, followed by an employer's confirmation of the continuation coverage end date, thus providing a comprehensive framework for both parties to address and manage the continuation of benefit coverage efficiently and transparently.

Maryland Continuation Election Sample

MARYLAND CONTINUATION ELECTION FORM

I wish to continue coverage under the <Name of Company> Employee Benefit Plan. I understand that this election is subject to the Plan. I have read and understand the MD Continuation Coverage Notice and the letter that accompanied this election form and both MD Continuation rights and limitations on those rights.

YES NO

IF YES, PLEASE ATTACH A NEW APPLICATION

Effective date of continuation coverage:

 

First payment is enclosed:

YES

NO

 

(If first payment is not enclosed, you will not be able to access health care coverage until payment is received.)

Qualifying Event:

Termination of Employment

Death

Divorce

Type of Insurance Selected:

Health

Dental Vision

(May not add lines of Insurance until Open Enrollment.)

Type of Coverage Selected:

Individual Husband/Wife Parent/Child

Family

 

 

 

 

 

 

(Dependents may not be added until Open Enrollment unless a

 

 

 

 

 

 

change in family status occurs.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Witness

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Employer to complete:

Continuation coverage end date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bill to Company:

 

 

 

 

Bill to Qualified Beneficiary:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Billing address

 

 

 

 

 

 

 

 

City

State

Zip
⇓ Maryland Continuation Election PDF

File Breakdown

Fact Description
Election Requirement The form must be used by individuals wishing to continue their coverage under the Employee Benefit Plan.
Understanding of Rights and Limitations Individuals must acknowledge they have read and understand the MD Continuation Coverage Notice, the accompanying letter, their continuation rights, and limitations on those rights.
Payment Requirement for Coverage Activation Coverage will not be accessible until the first payment is received if it is not enclosed with the form.
Qualifying Events Coverage continuation can be elected due to specific qualifying events such as termination of employment, death, or divorce.
Insurance Options Individuals can select from health, dental, and vision insurance but cannot add lines of insurance until Open Enrollment.
Coverage Options Coverage options include Individual, Husband/Wife, Parent/Child, and Family, with restrictions on adding dependents outside of Open Enrollment unless there's a change in family status.
Witness Requirement A witness's signature is required on the form in addition to that of the individual electing continuation.
Employer Responsibilities The employer must complete information regarding the continuation coverage end date and billing details.
Governing Law The form and the continuation of coverage are subject to Maryland law, specifically related to the state's provisions on health insurance continuation for employees.

Steps to Filling Out Maryland Continuation Election

Filling out the Maryland Continuation Election form is a necessary step for those who wish to continue their coverage under an Employee Benefit Plan after experiencing a qualifying event such as termination of employment, death, or divorce. This form is crucial for ensuring that your health coverage does not lapse during times when you might need it the most. Carefully reading and understanding the Maryland Continuation Coverage Notice and the accompanying letter before proceeding with the form is essential. Follow the steps below to accurately complete the Maryland Contination Election form.

  1. Start by stating your intention to continue coverage under the Name of Company Employee Benefit Plan by checking the box next to "YES" under the statement "I wish to continue coverage under the Employee Benefit Plan."
  2. Confirm that you have read and understand both the MD Continuation Coverage Notice and the accompanying letter by acknowledging this within the same section.
  3. Attach a new application to the form if you have checked "YES" to continue coverage.
  4. Indicate the effective date of continuation coverage in the space provided.
  5. Confirm whether the first payment is enclosed by checking "YES" or "NO." Remember, if the first payment is not enclosed, your coverage will not commence until the payment is received.
  6. Identify the qualifying event that has led to your election by selecting either Termination of Employment, Death, or Divorce.
  7. Select the type of insurance you wish to continue from the options provided: Health, Dental, or Vision. Note that new lines of insurance cannot be added until Open Enrollment.
  8. Choose the type of coverage you need: Individual, Husband/Wife, Parent/Child, or Family. Remember that dependents cannot be added until Open Enrollment unless there is a change in family status.
  9. Sign and date the form in the designated area to validate your election.
  10. Print your name and provide your Social Security Number in the spaces given.
  11. Have a witness sign the form to confirm your election.
  12. If you are the employer or acting on behalf of the employer, fill in the continuation coverage end date, decide who will be billed (Company or Qualified Beneficiary), and provide the billing address including city, state, and zip code.

Once the form is completed and submitted along with any necessary initial payment, your continuation coverage will be processed according to the terms of the plan. It's important to ensure that all information is accurate and that any required payments are made promptly to avoid delays in coverage.

More About Maryland Continuation Election

What is the Maryland Continuation Election Form?

The Maryland Continuation Election Form is a document that individuals fill out to continue their coverage under an Employee Benefit Plan after a qualifying event has occurred. This event could be the termination of employment, death, or divorce. By completing this form, individuals express their desire to keep their insurance benefits and agree to adhere to the rules and limitations set forth in the plan and the accompanying materials.

What qualifies as a "qualifying event" for continuation coverage?

Under the Maryland Continuation Coverage guidelines, a qualifying event includes the termination of employment, death, or divorce. These events trigger the option for an individual or their dependents to elect continuation coverage under the plan.

Can I select new types of insurance when electing continuation coverage?

No, individuals cannot add new lines of insurance when electing continuation coverage. Insurance selections such as Health, Dental, and Vision can only be modified during the plan's Open Enrollment period, unless a change in family status qualifies for an exception.

What types of coverage can I select under continuation coverage?

When electing continuation coverage, individuals can choose from the following types of coverage:

  • Individual
  • Husband/Wife
  • Parent/Child
  • Family
Note that dependents may not be added to the policy outside of the Open Enrollment period unless a qualifying change in family status occurs.

Is an initial payment required to start continuation coverage?

Yes, the first payment must be enclosed with the Maryland Continuation Election Form. If the first payment is not included, health care coverage will not be accessible until the payment is received. The effective date of continuation coverage is contingent upon this initial payment.

What information must be provided on the election form?

The election form requires various pieces of information, including:

  • A decision on whether to continue coverage
  • The effective date of continuation coverage
  • Whether the first payment is enclosed
  • The type of qualifying event
  • The type of insurance selected
  • The type of coverage selected
Additionally, the individual’s signature, the date, their printed name, and social security number, along with the signature of a witness, are required.

Who can elect continuation coverage?

Individuals who are qualified beneficiaries under the plan and who have experienced a qualifying event can elect continuation coverage. This includes employees, their spouses, and dependent children if they were covered under the Employee Benefit Plan prior to the qualifying event.

How is the continuation coverage end date determined?

The end date of continuation coverage is determined by the employer based on the plan’s terms and the specific circumstances surrounding the qualifying event. This date is indicated on the Maryland Continuation Election Form for clarity and record-keeping purposes.

Who is responsible for billing and payments for continuation coverage?

Responsibility for billing and payments can be billed directly to the company or the qualified beneficiary, as indicated on the form. The billing address, along with the city, state, and zip code, must be provided to ensure proper processing of continuation coverage payments.

Common mistakes

Filling out the Maryland Continuation Election form accurately is crucial for individuals looking to continue their health coverage under specific circumstances such as employment termination or change in family status. However, several common mistakes can lead to delays or denial of coverage. Recognizing these pitfalls can streamline the process and ensure that individuals maintain their health benefits without unnecessary disruption.

  1. Failing to attach a new application when indicating a desire to continue coverage under the "YES" option. The form explicitly states the necessity of this step, yet it is frequently overlooked.

  2. Omitting the first payment with the submission of the form. Without the initial payment, access to healthcare coverage is postponed until the payment is received, which is a detail often missed by applicants.

  3. Incorrectly identifying the qualifying event for continuation coverage. Individuals sometimes mark the wrong option or fail to specify their qualifying event, such as termination of employment, death, or divorce, which is critical for processing the request.

  4. Choosing insurance lines or coverage types that are not eligible for addition outside of the Open Enrollment period. Applicants might attempt to add dental or vision insurance or change their coverage type (e.g., from individual to family) without a recognized change in family status, leading to confusion and potential denial of these changes.

  5. Forgetting to sign and date the form or leaving the witness signature blank. The form requires both the applicant's signature and that of a witness to validate the request, and this step is sometimes overlooked.

  6. Not providing accurate or complete information for the billing section, especially when there is a choice between billing the company or the qualified beneficiary. An incorrect address or failure to specify the billing party can lead to billing issues and interrupted coverage.

To mitigate these errors, individuals should thoroughly review each section of the Maryland Continuation Election form, ensure all necessary documentation is attached, and double-check the forms for completeness and accuracy before submission. Moreover, understanding the eligibility requirements for continuation coverage and the impacts of different qualifying events can help in filling out the form correctly. Clear and accurate completion of the form is essential for a smooth transition and continued coverage.

Documents used along the form

When navigating the complexities of electing for continuation coverage under a company's Employee Benefit Plan in Maryland, understanding the supplementary forms and documents that often accompany the Maryland Continuation Election form is crucial. Tackling these documents enables a smoother transition and ensures clarity in the process for both the individual and the employer. Here are descriptions of four forms and documents that are frequently used together with the Maryland Continuation Election form.

  • MD Continuation Coverage Notice: This document provides detailed information about an individual's rights and obligations under the state's continuation coverage laws. It explains who is eligible, the length of coverage available, and what events can lead to the loss of continuation coverage. The notice serves as a comprehensive guide to help individuals understand the Maryland continuation coverage process.
  • New Application for Health Benefits: Often required to be attached with the Maryland Continuation Election form if the individual elects to continue coverage, this application collects personal and dependent information, along with the specific type and extent of coverage the individual desires. It is essential for assessing the individual’s current health coverage needs and processing them accordingly.
  • Qualifying Event Notification: This document is crucial for documenting the event that qualifies an individual for continuation coverage, such as termination of employment, death, divorce, or another significant life event. Proper completion of this form enables the insurer or employer to verify the event and determine the individual's eligibility for continuation of coverage.
  • Billing Information Form: Used to outline how payments for continuation coverage will be handled. This form details whether the bill will be sent directly to the company or the individual electing continuation, the billing address, and payment terms. It is essential for setting up the correct billing arrangements to ensure the coverage is not interrupted due to payment issues.

Together, these documents form a comprehensive toolkit that helps individuals navigate the Maryland continuation coverage election process. By understanding and correctly utilizing these forms, individuals can ensure they maintain the health coverage they need during transition periods. It is always advisable for individuals to thoroughly review each document and consult with a human resources representative or a legal advisor to address any uncertainties they may have during this process.

Similar forms

The Maryland Continuation Election form is similar to the COBRA Election Form used in federal employment law contexts. This is primarily because both forms provide a way for individuals to elect continuation of their health insurance coverage after experiencing a qualifying event that would otherwise result in the loss of coverage. Both forms require the individual to identify the type of qualifying event (such as termination of employment or divorce) and to choose the type of coverage they wish to continue (such as health, dental, or vision insurance). Additionally, both forms make clear that the election to continue coverage is subject to the terms of the plan under which the coverage is continued, emphasizing that the continuation is not automatic and requires an active election on the part of the individual.

Another document the Maryland Continuation Election form bears resemblance to is the State Continuation Coverage Notice that some states require in addition to, or in place of, federal COBRA coverage notices. Like the Maryland form, these state-specific notices are designed to inform individuals of their rights to continue health insurance coverage under certain state laws. They detail the circumstances under which continuation is possible, outline the process for electing continuation coverage, and stipulate the responsibilities of both the individual electing coverage and the entity providing it. While specifics can vary from state to state, the core purpose of informing individuals about their continuation rights and the process for maintaining coverage mirrors the objectives of the Maryland form.

Dos and Don'ts

Filling out the Maryland Continuation Election Form is a critical step in maintaining your health coverage after a significant life event. To ensure the process goes smoothly, here are do's and don'ts to keep in mind.

Do:
  • Read the Maryland Continuation Coverage Notice and accompanying letter carefully before filling out the form to fully understand your rights and the limitations of those rights.
  • Ensure that the type of coverage selected (Individual, Husband/Wife, Parent/Child, Family) accurately reflects your current needs and situation.
  • Clearly indicate your decision to continue coverage by marking 'YES' if you wish to continue under the Employee Benefit Plan.
  • Attach a new application if you're electing to continue your coverage, as required by the instructions.
  • Include payment for the first premium
  • Choose the correct qualifying event that applies to your situation, such as Termination of Employment, Death, or Divorce. This ensures that your continuation of coverage is processed under the correct terms.
  • Make a clear selection between health, dental, or vision insurance, in accordance with what is permitted by the plan until the next Open Enrollment period.
  • Sign and date the form to validate your election and provide your social security number for identification purposes.
  • Ensure that a witness signs the form, if required, to confirm the authenticity of your election.
  • Provide accurate billing information for yourself or the company, as applicable, to avoid any delays or issues with premium payments.
Don't:
  • Avoid rushing through the document without understanding each section. Take your time to ensure all information is correct and complete.
  • Don’t leave any section blank that is applicable to your situation. Incomplete forms may result in delays or denial of coverage.
  • Refrain from selecting coverage options that are not currently available to you or will not meet your needs during the continuation period.
  • Avoid adding dependents during a time that is not Open Enrollment unless you've experienced a qualifying change in family status.
  • Don’t forget to attach the required documents, such as a new application, if you're electing to continue coverage.
  • Avoid making selections or providing information that contradicts the rules of the plan or your understanding of your eligibility.
  • Do not overwrite or use correction fluid on the form—errors should be addressed by filling out a new form to maintain clarity and legibility.
  • Don’t forget to check the continuation coverage end date if mentioned by the employer on the form to know how long your continuation coverage is expected to last.
  • Refrain from delaying the submission of the form beyond any stated deadlines to ensure uninterrupted coverage.
  • Don’t neglect to review your form for errors or omissions before submitting it. Accuracy is key to ensuring your continuation of coverage is processed smoothly.

    • By following these guidelines, you can help ensure the Maryland Continuation Election Form is correctly filled out and submitted, safeguarding your health coverage during times of transition.

Misconceptions

There are several misconceptions about the Maryland Continuation Election form that can lead to confusion for both employees and employers. Understanding these misconceptions is crucial for making informed decisions about continuation coverage under the Maryland law.

  • Misconception 1: Coverage Can Begin Without First Payment

    There's a prevalent misunderstanding that once the continuation form is submitted, coverage is immediately activated, regardless of whether the first payment has been made. However, the form clearly states that if the initial payment is not included with the form submission, access to the health care coverage will be unavailable until the payment is received. This underscores the importance of submitting the initial payment to avoid any delays in coverage.

  • Misconception 2: Any Event Qualifies for Coverage Continuation

    Another misconception is the belief that any life event qualifies an individual for continuation coverage. In reality, only specific qualifying events, such as termination of employment, death, and divorce, trigger the eligibility for continuation of coverage under this form. Understanding the specified events helps in setting realistic expectations regarding continuation coverage eligibility.

  • Misconception 3: You Can Add Any Type of Insurance Immediately

    Many assume that upon election for continuation, they can add or change their insurance lines, including health, dental, and vision, at any time. The form, however, restricts changes to insurance lines until the Open Enrollment period, except for instances of a qualifying family status change. This limitation emphasizes the need for individuals to plan their insurance needs in advance, particularly around Open Enrollment periods.

  • Misconception 4: Easy Addition of Dependents to the Plan

    A common misunderstanding revolves around the ease of adding dependents to the plan once continuation coverage is elected. The form states that dependents cannot be added outside of Open Enrollment unless there's a change in family status. Being aware of this helps manage expectations and planning regarding dependent coverage.

  • Misconception 5: The Employer Decides the Continuation Coverage End Date

    There is often a misconception that it is solely up to the employer to decide when the continuation coverage ends. However, the form requires the employer to specify the continuation coverage end date based on the plan and the law, not arbitrary employer preference. Recognizing the predetermined nature of the coverage end date can help both employers and employees plan for coverage transitions more effectively.

Understanding these misconceptions is essential for employers and employees alike to navigate the intricacies of continuation coverage in Maryland accurately. This ensures that individuals can make informed decisions and avoid unintended gaps in their health insurance coverage.

Key takeaways

Filling out the Maryland Continuation Election form accurately is crucial for individuals wishing to continue their insurance coverage after a qualifying event. Here are some key takeaways to keep in mind:

  • Understand Your Coverage: Before filling out the form, make sure you fully comprehend the coverage options available under the plan, including health, dental, and vision insurance. It's vital to know that you cannot add new lines of insurance until the open enrollment period, except under specific circumstances such as a change in family status.
  • Know the Qualifying Events: Continuation of coverage is only available after certain life events, such as termination of employment, death, or divorce. Identifying the correct event on the form is essential for the election process.
  • Timely Payment is Critical: For your continuation coverage to become effective, the first payment must accompany the election form. Failure to include the initial payment will delay access to healthcare coverage until the payment is received. Always verify whether the first payment is enclosed before submitting the form.
  • Details Matter: When completing the form, it’s important to carefully fill out all sections, including the type of coverage selected (individual, husband/wife, parent/child, or family) and ensure that all information, including the effective date of continuation coverage and personal details, is correct and legible. Incorrect or incomplete information can lead to processing delays.

Completing the Maryland Continuation Election form accurately ensures a smoother transition and continuous coverage. Pay special attention to each part of the form and consult the accompanying MD Continuation Coverage Notice and any letters received with the form for additional guidance. Remember, clarity and accuracy in completing the form can significantly influence the timeliness and effectiveness of your insurance continuation.

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