Notice of Continuation Rights After Divorce You and your dependent

Notice of Continuation Rights After Divorce

You and your dependent child may be eligible under Maryland law to continue to be covered by

your former spouse’s group health insurance policy if:

• You and your spouse divorce, and

• You were covered under the spouse’s group hospital-medical policy or a

health maintenance organization (HMO) for at least 30 days prior to the divorce, and

• You do not now have other similar insurance.

If you wish to continue your health coverage, you or your former spouse MUST give your

spouse’s employer written notice no later than 60 days after the divorce.

IMPORTANT: You or your former spouse will be responsible for paying the entire cost of your

continuation coverage.

For further information about the program, you should contact your former spouse’s employer,

or if necessary telephone the Maryland Insurance Administration at 1-800-492-6116. There is

also more detailed information about Continuation Rights on the Maryland Insurance

Administration website at www.insurance.maryland.gov.

THIS NOTICE APPLIES TO STATE LAW. YOU MAY HAVE BROADER BENEFITS

UNDER FEDERAL LAW.

200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202

410-468-2000 1-800-492-6116

TTY: 1-800-735-2258