Health Insurance - Special Enrollment Period for Pregnancy - Coverage Effective Date
Summary
SB 794 expands Maryland’s health insurance rules for pregnancy-related special enrollment periods. Under current law, carriers must offer a 90-day special enrollment period when an individual or dependent becomes pregnant, as confirmed by a health care practitioner. This bill keeps that framework but adds a new choice for when coverage becomes effective for people enrolling during that pregnancy-triggered special enrollment period.
Specifically, an enrollee may choose either the first day of the month in which pregnancy is confirmed or the first day of the month following plan selection as the effective date of coverage. If the enrollee does not make a choice, the carrier must select one of those two dates. The bill applies to health benefit plans issued, delivered, or renewed on or after January 1, 2027, and takes effect the same day.
Impact
The bill amends Insurance Article § 15-1316 to change the effective-date rules for pregnancy-based special enrollment in both the Individual Exchange and off-exchange individual market. It does not change who qualifies for the special enrollment period or its 90-day duration, but it gives enrollees more flexibility and may require carriers to adjust enrollment systems, notices, and administrative procedures for plan effective dates beginning in 2027.
Sentiment
The bill appears to have broad support and little recorded opposition. It passed the Senate 45-0 and the House 128-1, indicating strong bipartisan approval. The committee report was favorable with amendments, suggesting the policy was generally accepted while still receiving some technical or administrative refinement.
Contention
The main policy issue is the timing of coverage and who controls the effective date during a pregnancy-triggered enrollment window. Supporters likely viewed the bill as improving consumer choice and access to timely prenatal coverage, while any concerns would center on carrier administration, premium timing, and the possibility of retroactive or earlier-than-expected coverage start dates. The final version resolves that by limiting the options to two specific effective dates and assigning a default choice to the carrier if the enrollee does not select one.