Md. Code Regs. 17.04.13.03

Current through Register Vol. 51, No. 25, December 13, 2024

Section 17.04.13.03 - Eligibility for Coverage and Subsidy

A. Eligible Persons. The following persons are eligible for Program coverage, with the exception of those persons listed in §B of this regulation:

(1) Employees whose coverage is required by law, full-time employees, and part-time employees as defined by State Personnel and Pensions Article, § 7-701, Annotated Code of Maryland, who are regularly paid salary or wages through an official State payroll center, including but not limited to:

(a) Central Payroll Bureau;

(b) Maryland Transit Administration; or

(c) The institutions of the University System of Maryland, including graduate assistants, and the Far East and European Divisions of the University of Maryland;

(2) Elected officials;

(3) Registers of wills and employees of the offices of registers of wills;

(4) Clerks of court and employees of the offices of clerks of court;

(5) Board or commission members who are regularly paid salary or wages and who work at least 50 percent of a normal workweek;

(6) Designated beneficiaries of deceased persons listed in §A(1)-(5), (7), and (8) of this regulation in accordance with State Personnel and Pensions Article, §§ 2-507, 2-508 and 2-509, Annotated Code of Maryland, with the following limitations:

(a) In the case of more than one dependent child receiving the allowances or distributions noted above, each dependent child who receives the allowance or distribution is eligible to enroll independently; and

(b) Notwithstanding any other provision in this regulation, a surviving spouse or surviving child must meet the requirements to be a dependent eligible for coverage as provided in §A(9) of this regulation;

(7)Retired employees who began State service on or before June 30, 2011, or who began State service on or after July 1, 2011 and are retirees of the Judges' Retirement System, and who qualify in accordance with §§A(7)(a) and (b) of this regulation. Neither service as a faculty member, teacher, or staff member for a community college or a local board of education prior or subsequent to State service, nor membership in the Teachers' Pension or Retirement Systems, shall in itself disqualify a former State employee who is otherwise eligible under §A(7)of this regulation. The only retired employees eligible for benefits under §A(7) of this regulation are those who:

(a) Receive a retirement allowance pursuant to State Personnel and Pensions Article, Division II, Annotated Code of Maryland, and who have:

(i) Retired directly from State service with a State retirement allowance on or after July 1, 1984, provided that the employee had at least 5 years of creditable service;

(ii) Terminated State service with 16 years or more of creditable service;

(iii) Terminated State service before July 1, 1984; or

(iv) Terminated State service with 10 years of creditable service and within 5 years of normal retirement age; or

(b) Receive a periodic distribution of benefits from the Maryland Optional Retirement Program under State Personnel and Pensions Article, Title 30, Annotated Code of Maryland, and who have:

(i) Ended service with a State institution of higher education with at least 10 years of service and were at least age 57;

(ii) Ended service with a State institution of higher education with at least 16 years of service; or

(iii) Retired directly from and had at least 5 years of service with a State institution of higher education on or after July 1, 1984;

(8) Retired employees who began State service on or after July 1, 2011, and who qualify in accordance with §§ 8(a) and (b) of this regulation. Neither service as a faculty member, teacher, or staff member for a community college or a local board of education prior or subsequent to State service, nor membership in the Teachers' Pension or Retirement Systems, shall in itself disqualify a former State employee who is otherwise eligible under §A(8) of this regulation. The only retired employees eligible for benefits under §A(8) of this regulation are those who:

(a) Receive a retirement allowance pursuant to State Personnel and Pensions Article, Division II, Annotated Code of Maryland, and who have:

(i) Retired directly from State service with a State retirement allowance provided that the employee had at least 10 years of creditable service;

(ii) Terminated State service with 25 years or more of creditable service; or

(iii) Terminated State service with 10 years of creditable service and within 5 years of normal retirement age; or

(b) Receive a periodic distribution of benefits from the Maryland Optional Retirement Program under State Personnel and Pensions Article, Title 30, Annotated Code of Maryland, and who have:

(i) Ended service with a State institution of higher education with at least 10 years of service and were at least age 57;

(ii) Ended service with a State institution of higher education with at least 25 years of service; or

(iii) Retired directly from and had at least 10 years of service with a State institution of higher education on or after July 1, 2011;

(9) Dependents of eligible persons listed in §A(1) - (5), (7), (8), (10), and (11) of this regulation who are one of the following:

(a) A spouse of an employee or retired employee; or

(b) A dependent child or another dependent child relative of an employee or retired employee, as identified in this chapter.

(10) Employees working less than 50 percent of a normal workweek and their designated beneficiaries, in accordance with Regulation .04B(3)chapter; and

(11) Contractual employees regularly working at least 30 hours per week, or an average of 130 hours per month, in accordance with 26 USC § 4980(H) and Regulation .04B(2) of this chapter.

B. Ineligible Dependents.

(1) Dependents of persons who are ineligible are likewise ineligible for coverage.

(2) When both spouses are covered as an employee or retired employee, neither is eligible to be enrolled both as a dependent under the spouse's coverage and as an employee or retiree for the same benefits plan. Dependent children of these individuals may be enrolled under either parent's coverage, but not both for the same benefits plan. An employee or retiree may provide coverage for his or her spouse who is also an employee provided that the spouse is not enrolled for coverage under the same benefits plan as an employee or retiree.

(3) Dependent children of employees who are also employees are not eligible to be enrolled as dependents under their parent's coverage if they have enrolled as individuals.

C. Subsidy.

(1) Except as provided in Regulation .04B of this chapter for contractual and part-time employees, the State subsidy as provided in the State budget for active employees is available to those individuals identified in §A(1)-(5) of this regulation and their dependents as described in §A(9) of this regulation.

(2) The State subsidy available for individuals described in §A(6) of this regulation shall be determined as provided in Regulation .05 of this chapter.

(3) The State subsidy available for individuals described in §A(7) and (8) of this regulation and their dependents as described in §A(9) of this regulation shall be determined as provided in Regulation .05 of this chapter, provided that the dependents of those retired employees described in §A(7)(b) and (8)(b) of this regulation are not entitled to any State subsidy unless the retired employee has a total of 25 or more years of service with the State in a permanent, non-contractual position in the Executive, Judicial, or Legislative branch of State government. Prorated credit for service is provided for less than full-time service in such positions.

(4) Contractual employees regularly working more than 30 hours per week, or more than an average of 130 hours per month, shall be provided a State subsidy of 75 percent of the premium cost for medical and prescription drug coverage. A measurement period may be necessary to establish the contractual employee's eligibility for the State subsidy.

(5) Employees working less than 50 percent of the workweek and contractual employees working less than 30 hours per week or 130 hours per month, as determined by either the employment contract or the Affordable Care Act measurement period analysis, shall not be provided a State subsidy.

Md. Code Regs. 17.04.13.03

Regulation .03A amended as an emergency provision effective January 1, 2005 (32:2 Md. R. 144); amended permanently effective June 6, 2005 (32:11 Md. R. 983)
Regulation .03A amended effective October 3, 2011 (38:20 Md. R. 1204)
Regulation .03 repealed and new Regulation .03 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 .03A amended effective September 20, 2010 (37:19 Md. R. 1284)
Regulation .03A, D amended effective July 1, 2009 (36:10 Md. R. 717); February 18, 2013 (40:3 Md. R. 219)
Regulation .03A, C, D amended as an emergency provision effective June 30, 2013 (40:15 Md. R. 1227); amended permanently effective October 14, 2013 (40:20 Md. R. 1653)
Regulation .03 amended effective 42:3 Md. R. 317, eff.2/16/2015; amended effective 45:4 Md. R. 207, eff. 2/26/2018