reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-915 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-915 - Conformity With Federal Law

    (a)    The Commissioner shall adopt reasonable regulations as necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations.    (b)    The regulations may include, but are not limited to, provisions that:        (1)    require rate adjustments, credits, or refunds if the Medicare supplement policies or certificates do not meet loss ratio requirements;        (2)    establish a uniform methodology for calculating and reporting loss ratios;        (3)    ensure public access to policies, premiums, and loss ratio information of carriers of Medicare supplement insurance;        (4)    establish a process for approving or disapproving policy forms and certificate forms; and        (5)    establish a policy for holding public hearings before approval of premium increases and a process for approving or disapproving proposed schedules of premium changes.
MD. Insurance Code Ann. §  15-916 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-916 - Medicare Supplement Buyer's Guide

    (a)    The Commissioner shall prepare in clear, plain English the text of a Medicare supplement buyer’s guide that carriers must provide to prospective buyers of Medicare supplement policies under this section.    (b)    The buyer’s guide shall:        (1)    contain an outline of Medicare coverage; and        (2)    include advice and other information about purchasing Medicare supplement policies, including a reference to the right of the buyer to cancel a Medicare supplement policy during the first 30 days after it is delivered, as provided in § 15-910 of this subtitle.    (c)    The Commissioner shall submit the text of the buyer’s guide for publication in the Maryland Register and at the same time send a copy of the text to the Department of Aging.    (d)    The carrier or insurance producer of the carrier shall deliver to the prospective buyer a Medicare supplement buyer’s guide that is printed in at least 12-point type:        (1)    before accepting an application;        (2)    when an existing policy is converted to a Medicare supplement policy; and        (3)    at any other time required by the Commissioner by regulation.    (e)    A carrier shall provide:        (1)    a copy of the Medicare supplement buyer’s guide to an individual covered under a group health insurance policy when the individual becomes eligible for Medicare by reason of age; and        (2)    any information required under § 15-919 of this subtitle that is applicable to the continuing coverage under the group health insurance policy of the individual eligible for Medicare.    (f)    (1)    The text of the Medicare supplement buyer’s guide shall be as the Commissioner submits for publication under subsection (c) of this section.        (2)    The form of the Medicare supplement buyer’s guide shall be as required by the Commissioner by regulation.
MD. Insurance Code Ann. §  15-917 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-917 - Outline of Coverage

    (a)    In order to provide for full and fair disclosure in the sale of Medicare supplement policies, a Medicare supplement policy or certificate may not be delivered in the State unless an outline of coverage is provided to the applicant at the time the application is delivered.    (b)    (1)    In this subsection, “format” means style, arrangements, and overall appearance, including the size, color, and prominence of type and arrangement of text and captions.        (2)    The Commissioner shall prescribe the format and content of the outline of coverage required by this section.        (3)    The outline of coverage shall include:            (i)    a description of the principal benefits and coverage provided in the Medicare supplement policy;            (ii)    a statement of the exceptions, reductions, and limitations contained in the Medicare supplement policy;            (iii)    a statement of the renewal provisions, including any reservation by the carrier of a right to change premiums;            (iv)    disclosure of the existence of any automatic renewal premium increases based on the policyholder’s age; and            (v)    a statement that the outline of coverage is a summary of the Medicare supplement policy that is issued or applied for and that the Medicare supplement policy should be consulted to determine governing contractual provisions.
MD. Insurance Code Ann. §  15-918 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-918 - Informational Brochure

    (a)    The Commissioner may prescribe by regulation a standard form and the contents of an informational brochure for individuals eligible for Medicare by reason of age, which is intended to improve the buyer’s ability to choose the most appropriate coverage and to improve the buyer’s understanding of Medicare.    (b)    Except for direct response insurance policies, the Commissioner may require by regulation that the informational brochure be provided to each prospective insured eligible for Medicare at the time of delivery of the outline of coverage.    (c)    For direct response insurance policies, the Commissioner may require by regulation that the informational brochure be provided on request to a prospective insured eligible for Medicare by reason of age, but not later than the time of delivery of the policy.
MD. Insurance Code Ann. §  15-919 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-919 - Required Statements to Prospective Buyers

    (a)    (1)    Under any circumstance stated in this section, a carrier or insurance producer of a carrier shall give to a prospective buyer eligible for Medicare by reason of age a written statement as required, for each circumstance, by this section.        (2)    The written statement shall be given before the carrier or insurance producer accepts an application.    (b)    If the proposed policy excludes or limits benefits for preexisting conditions, a statement shall be given that describes in plain language the limitations or exclusions.    (c)    If the proposed policy provides coverage for care in a Medicare–approved skilled nursing facility, but the policy does not provide coverage for care in other nursing home facilities or for custodial or rest home care, a statement shall be given that describes clearly those expenses that the policy does not cover.    (d)    (1)    If the proposed policy does not comply with the requirements of §§ 15–904, 15–906, 15–907, and 15–908 of this subtitle for a Medicare supplement policy, a statement printed in 12–point type shall be given that:    “This policy (or certificate) is not a Medicare supplement policy (or certificate). It is not designed to fill the ‘gaps’ of Medicare. If you are eligible for Medicare, review the Medicare supplement buyer’s guide available from the company”.        (2)    The statement required by paragraph (1) of this subsection shall be printed on or attached to the first page of:            (i)    the policy form or certificate; or            (ii)    an outline of coverage delivered to the individual covered under the policy or certificate.        (3)    A carrier or insurance producer of a carrier need not provide the statement required under paragraph (1) of this subsection for:            (i)    a policy or certificate that is issued in accordance with a contract under § 1876 of the federal Social Security Act, 42 U.S.C. § 1395mm;            (ii)    a disability income policy; or            (iii)    a policy or contract of one or more employers or labor organizations or the trustees of a fund established by one or more employers or labor organizations or a combination of employers or labor organizations, for employees, former employees, a combination of employees or former employees, members, former members, or a combination of members or former members of the labor organization.        (4)    Notwithstanding paragraph (1) of this subsection, the Commissioner shall adopt regulations necessary to conform this subsection to the requirements of applicable federal law.    (e)    If the proposed policy provides accident–only benefits, a statement printed in 12–point type shall be given that contains the language in subsection (d) of this section and the following:    “This is an accident only policy. It does not pay benefits for loss due to sickness”.
MD. Insurance Code Ann. §  15-920 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-920 - Caption and Notice Requirements

    The Commissioner may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not Medicare supplement coverages, for all health insurance policies sold to individuals eligible for Medicare, other than Medicare supplement policies or disability income policies.
MD. Insurance Code Ann. §  15-921 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-921 - Disclosure of Information About Replacement of Policies

    The Commissioner may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of health insurance policies, subscriber contracts, or certificates by individuals eligible for Medicare.
MD. Insurance Code Ann. §  15-922 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-922 - Compensation of Insurance Producer and Other Representatives

    (a)    (1)    In this section, “compensation” means any pecuniary or nonpecuniary remuneration related to the sale or renewal of a Medicare supplement policy or certificate.        (2)    “Compensation” includes bonuses, gifts, and finders’ fees.        (3)    “Compensation” does not include noncash prizes or awards.    (b)    A carrier or other entity may provide a commission or other compensation to an insurance producer or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is not more than 200% of the commission or other compensation paid for selling or servicing the Medicare supplement policy or certificate in the second year or period.    (c)    A carrier or other entity must provide the same commission or other compensation in subsequent renewal years as the commission or other compensation provided in the second year or period and for no fewer than 5 renewal years.    (d)    If an existing Medicare supplement policy or certificate is replaced, the carrier or other entity may not provide to its insurance producers or other producers, and an insurance producer or other producer may not receive, compensation greater than the renewal compensation payable by the succeeding carrier on renewal Medicare supplement policies or certificates.
MD. Insurance Code Ann. §  15-923 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-923 - Review of Policy Advertisements

    Each carrier that offers a Medicare supplement policy in the State shall provide a copy of any Medicare supplement advertisement that the carrier intends to use in the State whether through a written, radio, or television medium to the Commissioner for review at least 5 business days before the carrier uses the advertisement.
MD. Insurance Code Ann. §  15-924 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-924 - Solicitations of Sales of Health Insurance Policies to Individuals Eligible for Medicare

    (a)    Solicitation of the sale of a health insurance policy proposed to be issued to an individual eligible for Medicare may be made only in accordance with this section and § 15-925 of this subtitle.    (b)    (1)    When soliciting the sale of a health insurance policy to an individual eligible for Medicare, a carrier or insurance producer shall ask the individual whether the individual:            (i)    is already covered by an existing Medicare supplement policy; and            (ii)    is entitled to Medicaid benefits.        (2)    The carrier or insurance producer shall obtain a written statement from the individual that verifies the individual’s information provided under paragraph (1) of this subsection.    (c)    When soliciting or advertising the sale of a health insurance policy to an individual eligible for Medicare, a carrier or insurance producer may not:        (1)    represent or imply that the carrier or insurance producer represents, works for, or is compensated by a federal, State, or local government agency;        (2)    falsely represent or imply that the carrier or insurance producer is offering insurance to supplement Medicare that is approved or recommended by a federal, State, or local government agency;        (3)    use terms such as “Medicare consultant”, “Medicare advisor”, “Medicare bureau”, or “disability insurance consultant” when describing the carrier or insurance producer in a letter, envelope, reply card, or any other writing or advertisement or in any oral representation; or        (4)    knowingly make a misrepresentation or incomplete or fraudulent comparison by commission or omission of a policy or carrier to induce or attempt to induce the individual to:            (i)    purchase, amend, lapse, surrender, forfeit, change, duplicate, or not renew coverage already in force;            (ii)    replace a policy that is only technically at variance with the policy being offered by the carrier or insurance producer; or            (iii)    take out a policy with another carrier.
MD. Insurance Code Ann. §  15-925 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-925 - Prohibited Solicitations

    (a)    When soliciting the sale of a health insurance policy, a carrier or insurance producer may not knowingly offer a Medicare supplement policy to an individual not eligible for Medicare.    (b)    A carrier or insurance producer may only sell or offer to sell a Medicare supplement policy to an individual eligible for Medicaid benefits in accordance with the provisions of 42 U.S.C. § 1395ss and this subtitle.    (c)    A carrier or insurance producer may not negligently or knowingly sell or offer to sell to an individual a Medicare supplement policy that duplicates to any extent an existing Medicare supplement policy that covers that individual.    (d)    A carrier or insurance producer may not use the terms “Medicare supplement”, “Medigap”, or other words of similar meaning in advertising or otherwise in soliciting the sale of a health insurance policy or other policy, unless the policy conforms to §§ 15-904, 15-906, 15-907, and 15-908 of this subtitle.
MD. Insurance Code Ann. §  15-926 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-926 - Information to Health Care Financing Administration

    (a)    Each carrier that issues Medicare supplement policies shall provide to CMS any data, statistics, or other information that CMS requests about the carrier’s Medicare supplement policies.    (b)    On request from CMS, the Commissioner may provide to CMS any information about Medicare supplement policies that are issued in the State.
MD. Insurance Code Ann. §  15-927 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-927 - Penalties

    In addition to any other applicable penalties for violations of this article, the Commissioner may require a carrier that violates this subtitle or a regulation adopted under this subtitle to cease marketing any Medicare supplement policy or certificate in the State that is related directly or indirectly to the violation, or may require the carrier to take actions necessary to comply with this subtitle, or both.
MD. Insurance Code Ann. §  15-928 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-928 - Short Title

    This subtitle is the Medicare Supplement Act.
MD. Insurance Code Ann. §  15-1001 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10 - Claims and Utilization Review|Section 15-1001 - Requirement for Utilization Review

    (a)    This section applies to entities that propose to issue or deliver individual, group, or blanket health insurance policies or contracts in the State or to administer health benefit programs that provide for the coverage of health care services and the utilization review of those services, including:        (1)    an authorized insurer that provides health insurance in the State;        (2)    a nonprofit health service plan;        (3)    a health maintenance organization;        (4)    a dental plan organization; or        (5)    except for a managed care organization as defined in Title 15, Subtitle 1 of the Health - General Article, any other person that provides health benefit plans subject to regulation by the State.    (b)    (1)    Subject to paragraph (2) of this subsection, each entity subject to this section shall:            (i)    1.    have a certificate issued under Subtitle 10B of this title; or                2.    contract with a private review agent that has a certificate issued under Subtitle 10B of this title; and            (ii)    when conducting utilization review for mental health and substance use benefits, ensure that the criteria and standards used are in compliance with the federal Mental Health Parity and Addiction Equity Act.        (2)    For hospital services, each entity subject to this section may contract with or delegate utilization review to a hospital utilization review program approved under § 19–319(d) of the Health – General Article.    (c)    Notwithstanding any other provision of this article, if the medical necessity of providing a covered benefit is disputed, an entity subject to this section that does not meet the requirements of subsection (b) of this section shall pay any person entitled to reimbursement under the policy or contract in accordance with the determination of medical necessity by:        (1)    the treating provider; or        (2)    when hospital services are provided, the hospital utilization review program approved under § 19-319(d) of the Health - General Article.    (d)    An entity subject to this section may not:        (1)    act as a private review agent without holding a certificate issued under Subtitle 10B of this title; or        (2)    use a private review agent that does not hold a certificate issued under Subtitle 10B of this title.    (e)    An entity that violates any provision of this section is subject to the penalties provided under § 15-10B-12 of this title.
MD. Insurance Code Ann. §  15-1002 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10 - Claims and Utilization Review|Section 15-1002 - Claim Forms to Conform to Regulations

    To provide a standard system of payment for medical services, each claim form for use under an individual or group health insurance policy that is issued or delivered in the State shall conform to a form or regulations that the Commissioner adopts.
MD. Insurance Code Ann. §  15-1003 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10 - Claims and Utilization Review|Section 15-1003 - Adoption of Uniform Claims Forms Required

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    (i)    “Health care practitioner” means a person that is licensed or certified under the Health Occupations Article and reimbursed by a third party payor.            (ii)    “Health care practitioner” does not include a physician or other person licensed or certified under this article when the physician or other person is rendering care to a member or subscriber of a health maintenance organization and is compensated by the health maintenance organization for that care on a salaried or capitated basis.        (3)    “Hospital” has the meaning stated in § 19-301 of the Health - General Article.    (b)    The Commissioner shall adopt by regulation as the uniform claims form for reimbursement of hospital services in the State the uniform claims form adopted by the National Uniform Billing Committee and approved by the Centers for Medicare and Medicaid Services for Hospital Payments under Title XVIII of the Social Security Act.    (c)    The Commissioner shall adopt by regulation a uniform claims form for reimbursement of health care practitioners’ services.    (d)    (1)    The Commissioner shall adopt by regulation:            (i)    a definition of a clean claim, including:                1.    the essential data elements that must be completed on the uniform claims form; and                2.    uniform standards for attachments to the uniform claims form;            (ii)    permissible categories of disputed claims for which additional information may be requested under §§ 15-1004(c) and 15-1005(c) of this subtitle; and            (iii)    standards for determining when a claim is considered received for reimbursement.        (2)    In adopting the regulations required under paragraph (1)(i) of this subsection, the Commissioner shall consider:            (i)    standards for attachments required by the federal Centers for Medicare and Medicaid Services for the Medicare Program;            (ii)    standards used by insurance carriers, nonprofit health service plans, and health maintenance organizations in the State; and            (iii)    federal regulations adopted under the Health Insurance Portability and Accountability Act.
MD. Insurance Code Ann. §  15-1006 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10 - Claims and Utilization Review|Section 15-1006 - Notice of Reason for Denial of Claim

    (a)    On written request of the claimant, an insurer that denies a claim made on an individual health insurance policy shall give written notice to the claimant that states fully the reason for the denial.    (b)    The reason given by an insurer for denial of a claim shall not act as an estoppel or limit the insurer from offering an additional reason for the denial.    (c)    The notice given by an insurer under this section is subject to 45 C.F.R. § 164.522(b).
MD. Insurance Code Ann. §  15-1007 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10 - Claims and Utilization Review|Section 15-1007 - Summary Explanation of Benefits

    (a)    This section applies to insurers and nonprofit health service plans that propose to issue or deliver individual, group, or blanket health insurance policies or contracts or to administer health benefit programs that provide hospital, medical, or surgical benefits on an expense–incurred basis.    (b)    Each entity subject to this section shall provide to an insured individual who has filed a claim described in subsection (c) of this section an annual summary explanation of benefits that covers the preceding 12–month period.    (c)    The summary explanation of benefits required under subsection (b) of this section shall provide a summary of:        (1)    all claims filed by health care providers for services rendered to the insured individual or covered dependent of the insured individual during an inpatient hospitalization or an outpatient surgical procedure;        (2)    the amount paid by the entity for each claim filed; and        (3)    the balance owed by the insured individual for each claim filed.    (d)    The explanation of benefits required under this section is subject to 45 C.F.R. § 164.522(b).