reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-406 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-406 - Medical Assistance

    (a)    In this section, “health insurance coverage” means health care coverage under which medical care services can be provided to a child.    (b)    This section applies to:        (1)    commercial insurers, nonprofit health service plans, and health maintenance organizations that operate in the State under a certificate of authority;        (2)    group health plans, as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 (ERISA); and        (3)    persons that offer a service benefit plan, as defined in federal law.    (c)    An entity subject to this section may not consider whether an individual is eligible for or receives medical assistance from this State or another state under 42 U.S.C. § 1396a when:        (1)    determining the eligibility of the individual for enrollment in health insurance coverage; or        (2)    calculating any payments for benefits for which the individual is eligible under the health insurance coverage.    (d)    On presentation of a claim, an entity subject to this section shall reimburse the State to the extent that:        (1)    the State has paid for expenses for health care services that are provided to an eligible individual and covered under the Maryland Medical Assistance Program; and        (2)    those health care services are included under the individual’s health insurance coverage provided by the entity.    (e)    If a State agency has been assigned the rights of an individual who is eligible for medical assistance and who has health insurance coverage provided by an entity subject to this section, the entity may not impose on the State agency requirements that are different from the requirements that apply to an insurance producer, assignee, or any other individual who has health insurance coverage provided by the entity.
MD. Insurance Code Ann. §  15-409.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-409.1 - Continuation Coverage for Involuntarily Terminated Employees -- Small Employers

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Act” means the federal American Recovery and Reinvestment Act of 2009 (P.L. 111–5).        (3)    “Carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan; or            (iii)    a health maintenance organization.        (4)    “Small employer” has the meaning stated in § 15–1201 of this title.    (b)    This section applies to a carrier that issues health benefit plans to small employers in accordance with Subtitle 12 of this title.    (c)    A carrier shall allow an extended election period for continuation coverage under § 15–409 of this subtitle if the individual:        (1)    was involuntarily terminated from employment by a small employer between September 1, 2008, and February 16, 2009, inclusive, as described in § 3001(a)(3)(C) of the Act;        (2)    is an assistance eligible individual, as defined in § 3001(a)(3) of the Act, or would be an assistance eligible individual if an election of continuation coverage under § 15–409 of this subtitle was in effect on the date of enactment of the Act; and        (3)    was eligible for continuation coverage under § 15–409 of this subtitle at the time of the individual’s termination of employment.    (d)    The extended election period provided under this section shall continue until 60 days after provision of the notification required by § 3001(a)(7)(C) of the Act if the notification describes the extended election period required under this section.    (e)    Any continuation coverage elected by an individual during an extended election period under this section:        (1)    shall begin during the first period of coverage beginning on or after the individual’s election of continuation coverage; and        (2)    may not extend beyond the period of continuation coverage that would have been required under § 15–409 of this subtitle if the coverage had been elected as required under that section.
MD. Insurance Code Ann. §  15-411 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-411 - Open Enrollment of Involuntarily Terminated Spouse Losing Coverage

    (a)    Each group health insurance contract or policy that is issued by an insurer or nonprofit health service plan shall provide continuous open enrollment for the purpose of allowing a married employee who is enrolled under the contract or policy to alter the terms of the employee’s coverage to include the employee’s spouse or children if the employee’s spouse loses coverage under another group health insurance contract or policy because of the involuntary termination of the spouse’s employment other than for cause.    (b)    A group health insurance contract or policy may not require evidence of insurability for a spouse who qualifies for group health insurance coverage under this section.    (c)    A married employee who wishes to alter the terms of the employee’s coverage under this section shall notify the employer within 6 months after the date on which the coverage of the employee’s spouse under another group health insurance contract or policy terminates.
MD. Insurance Code Ann. §  15-416 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-416 - Notice to Parents of Impending Loss of Child's Coverage

    (a)    This section applies to insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery in the State individual, group, or blanket health insurance policies and contracts.    (b)    At least 60 days before a child who is covered under a parent’s individual, group, or blanket health insurance policy or contract reaches the limiting age under the policy or contract, an entity subject to this section shall:        (1)    notify the parent of criteria under which a child may remain eligible for coverage as a dependent under the policy or contract; and        (2)    provide information regarding:            (i)    any other policies that may be available to the child from the entity; and            (ii)    the availability of additional information from the Administration regarding individual policies in the State.    (c)    The Commissioner shall establish and publish by bulletin the notice to be given under this section.
MD. Insurance Code Ann. §  15-417 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-417 - Coverage for Part-Time Students With Disabilities

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (b)    An entity subject to this section that provides health benefits to full-time students over the age of 18 may not exclude health benefits for a student over the age of 18 who:        (1)    is enrolled less than full time as a result of a documented disability that prevents the student from maintaining a full-time course load; and        (2)    is maintaining a course load of at least 7 credit hours per semester.    (c)    An entity subject to this section may require the insured, subscriber, or enrollee to provide verification of the disability from a disability services professional employed by the institution of higher education that the student attends or a health care provider with special expertise in and knowledge of the disability.
MD. Insurance Code Ann. §  15-418 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies|Section 15-418 - Child Dependent Coverage

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan; or            (iii)    a health maintenance organization.        (3)    “Child dependent” means an individual who:            (i)    is:                1.    the grandchild of the insured; or                2.    a child who is entitled to dependent coverage under § 15–403.1 of this subtitle;            (ii)    is unmarried; and            (iii)    is under the age of 25 years.    (b)    (1)    This section applies to:            (i)    each policy of individual or group health insurance that is issued in the State;            (ii)    each contract that is issued in the State by a nonprofit health service plan; and            (iii)    each contract that is issued in the State by a health maintenance organization.        (2)    Notwithstanding paragraph (1) of this subsection, this section does not apply to:            (i)    a contract covering one or more, or any combination of the following:                1.    coverage only for loss caused by an accident;                2.    disability coverage;                3.    credit–only insurance; or                4.    long–term care coverage; or            (ii)    the following benefits if they are provided under a separate contract:                1.    dental coverage;                2.    vision coverage;                3.    Medicare supplement insurance;                4.    coverage limited to benefits for a specified disease or diseases;                5.    travel accident or sickness coverage; and                6.    fixed indemnity limited benefit insurance that does not provide benefits on an expense incurred basis.    (c)    Each policy or contract subject to this section that provides coverage for dependents shall:        (1)    include coverage for a child dependent;        (2)    provide the same health insurance benefits to a child dependent that are available to any other covered dependent; and        (3)    provide health insurance benefits to a child dependent at the same rate or premium applicable to any other covered dependent.    (d)    This section does not limit or alter any right to dependent coverage or to the continuation of coverage that is otherwise provided for in this article.
MD. Insurance Code Ann. §  15-501 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-501 - Increased Social Security Payments

    An individual, group, or blanket health insurance contract may not contain a provision that reduces payments to an individual entitled to receive disability payments under the contract because the individual receives an increase in Social Security payments.
MD. Insurance Code Ann. §  15-502 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-502 - Eligibility for State Medical Assistance

    (a)    This section applies to each individual or group policy or certificate of health insurance or automobile insurance that is:        (1)    delivered or issued for delivery in the State by an insurer or nonprofit health service plan; and        (2)    issued, renewed, amended, or reissued on or after July 1, 1978.    (b)    A policy or certificate subject to this section that provides or pays for health care benefits may not contain a provision that denies or reduces benefits because services are rendered to a policyholder, certificate holder, or beneficiary who is eligible for or receives medical assistance under § 15-103 of the Health - General Article.
MD. Insurance Code Ann. §  15-503 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-503 - Exposure to Diethylstilbestrol

    An insurer or nonprofit health service plan may not deny, cancel, or refuse to renew an individual, group, or blanket health insurance policy solely because the insured has been exposed to diethylstilbestrol, commonly known as DES.
MD. Insurance Code Ann. §  15-505 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-505 - Exclusion of Payments for Leaving Home Confinement

    (a)    This section applies to each individual, group, or blanket health insurance policy or certificate that is issued by an insurer or nonprofit health service plan on or after July 2, 1970, covering a person in the State.    (b)    (1)    A policy or certificate subject to this section that provides coverage for disability or sickness while an individual is confined at home may not exclude payments or benefits because the individual leaves home for medical treatment.        (2)    Coverage extends to individuals confined at home, who are otherwise eligible, regardless of the place of medical treatment.
MD. Insurance Code Ann. §  15-506 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-506 - Effect of Marital Status on Maternity Benefits

    (a)    Each insurer and nonprofit health service plan that provides maternity benefits in a policy form customarily issued on an individual or family basis shall offer the benefits to individuals regardless of marital status.    (b)    (1)    This subsection applies to each group or blanket health insurance policy that is delivered or issued for delivery in the State by an insurer or nonprofit health service plan.        (2)    Each policy subject to this subsection that provides maternity benefits for pregnancy and childbirth of employees or members or of covered dependents of employees or members, whether the benefits are in the form of disability, hospital, medical, or surgical benefits, shall provide identical benefits regardless of marital status to:            (i)    all covered employees or members; or            (ii)    all covered employees or members and all covered dependents of employees or members.
MD. Insurance Code Ann. §  15-508.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-508.1 - Exclusionary Provisions

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means an insurer or a nonprofit health service plan.        (3)    “Exclusionary rider” means an endorsement to an individual health benefit plan that excludes benefits for one or more named conditions that are discovered by a carrier during the underwriting process.        (4)    “Health benefit plan” has the meaning stated in § 15–1301 of this title.        (5)    “Individual health benefit plan” means a health benefit plan issued by a carrier that insures:            (i)    only one individual; or            (ii)    one individual and one or more family members of the individual.    (b)    This section applies to individual health benefit plans that are issued or delivered in the State before March 23, 2010.    (c)    A carrier may not attach an exclusionary rider to an individual health benefit plan unless the carrier obtains the prior written consent of the policyholder.    (d)    A carrier may impose a preexisting condition exclusion or limitation on an individual for a condition that was not discovered during the underwriting process for an individual health benefit plan only if the exclusion or limitation:        (1)    relates to a condition of the individual, regardless of its cause, for which medical advice, diagnosis, care, or treatment was recommended or received within the 12–month period immediately preceding the effective date of the individual’s coverage; and        (2)    extends for a period of not more than 12 months after the effective date of the individual’s coverage.
MD. Insurance Code Ann. §  15-510 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage|Section 15-510 - Behavioral Health Care Services Provided at Public School or School-Based Health Center

    No individual, group, or blanket insurance policy or contract issued or delivered in the State by an insurer, a nonprofit health service plan, or a health maintenance organization may deny a covered medically necessary behavioral health care service provided by a participating provider to a member who is a student solely on the basis that the service is provided at a public school or through a school–based health center under § 7–440 of the Education Article.
MD. Insurance Code Ann. §  15-601 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 6 - Required Reimbursement of Institutions|Section 15-601 - Benefits for Using Low-Cost Hospitals

    (a)    This section applies to insurers and nonprofit health service plans that provide hospital benefits in the State under individual, group, or blanket health insurance policies.    (b)    Each entity subject to this section that offers benefits to an insured or beneficiary who uses designated low-cost hospitals, that are different from the benefits offered when other hospitals are used, shall base its designation of a low-cost hospital on information that:        (1)    excludes the reasonable cost of medical education and of uncompensated care as determined by the Health Services Cost Review Commission;        (2)    excludes the cost associated with a shock trauma facility as determined by the Health Services Cost Review Commission;        (3)    excludes the amount in rates approved by the Health Services Cost Review Commission for undergraduate nursing education;        (4)    excludes from consideration each hospital that is determined by the Maryland Health Care Commission to be a sole community provider; and        (5)    compares hospitals on a regional basis, unless the entity demonstrates to the satisfaction of the Commissioner that a statewide comparison is more appropriate.    (c)    An entity subject to this section that provides hospital benefits under subsection (b) of this section may not subsidize those benefits from premiums earned by other benefit plans, programs, or policies.
MD. Insurance Code Ann. §  15-602 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 6 - Required Reimbursement of Institutions|Section 15-602 - Treatment in State or Local Government Hospitals or Institutions

    (a)    This section applies to each individual, group, or blanket health insurance policy or certificate that is delivered or issued for delivery in the State by an insurer or nonprofit health service plan on or after July 2, 1969.    (b)    A policy or certificate subject to this section may not exclude payments or benefits for the treatment of tuberculosis, mental illness, or another illness covered under the policy or certificate because treatment is received in a hospital or other institution of the State or of a county or municipal corporation of the State, whether or not the hospital or other institution is deemed charitable.
MD. Insurance Code Ann. §  15-603 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 6 - Required Reimbursement of Institutions|Section 15-603 - Reimbursement of Maryland Department of Health

    (a)    If the Maryland Department of Health notifies an insurer or nonprofit health service plan that the Department has paid for or provided services to an individual who is covered under an individual, group, or blanket health insurance policy or contract that the insurer or nonprofit health service plan issued, delivered, or renewed in the State, the insurer or nonprofit health service plan shall reimburse the Department for the cost of the services, regardless of any provision in the health insurance policy or contract that requires payment to the policyholder, subscriber, or another payee.    (b)    (1)    The benefits payable to the Maryland Department of Health under this section are limited to those benefits available under the terms and conditions of the health insurance policy or contract for the services paid for or provided by the Department.        (2)    An insurer or nonprofit health service plan is not required to make payment to the Department under this section if, before receiving notice from the Department under subsection (a) of this section, the insurer or nonprofit health service plan has paid the benefits available under the health insurance policy or contract in good faith and in accordance with the terms and conditions of the policy or contract.    (c)    Notwithstanding any other provision of a health insurance policy, contract, or certificate, an insurer or nonprofit health service plan may not refuse to reimburse the Maryland Department of Health because of the manner, form, or date of a claim for reimbursement if, within 2 years after the date of the service for which reimbursement is sought, the Department provides to the insurer or nonprofit health service plan sufficient information to determine the liability of the insurer or nonprofit health service plan.
MD. Insurance Code Ann. §  15-604 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 6 - Required Reimbursement of Institutions|Section 15-604 - Rates for Payments to Hospitals; Compliance With All-Payor Model Contract

    Each authorized insurer, nonprofit health service plan, and fraternal benefit society, and each managed care organization that is authorized to receive Medicaid prepaid capitation payments under Title 15, Subtitle 1 of the Health – General Article, shall:        (1)    pay hospitals for hospital services rendered on the basis of the rate approved by the Health Services Cost Review Commission; and        (2)    comply with the applicable terms and conditions of the all–payer model contract, as defined in § 19–201 of the Health – General Article.
MD. Insurance Code Ann. §  15-701 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 7 - Required Reimbursement for Services of Health Care Providers|Section 15-701 - Licensed Health Care Providers

    (a)    (1)    This subsection applies to each individual or group health insurance policy, contract, or certificate that is:            (i)    delivered or issued for delivery in the State by an insurer or nonprofit health service plan; and            (ii)    issued, renewed, amended, or reissued on or after July 1, 1984.        (2)    Notwithstanding any other provision of a policy, contract, or certificate subject to this subsection, if the policy, contract, or certificate provides for reimbursement for a service that is within the lawful scope of practice of a health care provider licensed under the Health Occupations Article, the insured or any other person covered by or entitled to reimbursement under the policy, contract, or certificate is entitled to reimbursement for the service.    (b)    An individual or group disability insurance policy or contract that is delivered or issued for delivery in the State may not contain a provision that precludes a licensed health care provider from attesting to the rendition of service that is within the lawful scope of practice of the attesting provider.