reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-1A-13 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-13 - Identification of Participating Primary Care Provider -- Children -- Obstetrical or Gynecological Care

    (a)    If a carrier requires or provides for the designation of a participating primary care provider for an insured individual, the carrier shall allow each insured individual to designate any participating primary care provider if the provider is available to accept the insured individual.    (b)    (1)    (i)    This subsection applies only to an individual who has a child who is an insured individual under the individual’s health benefit plan.            (ii)    This subsection may not be construed to waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of pediatric care.        (2)    If a carrier requires or provides for the designation of a participating primary care provider for a child, the carrier shall allow the individual to designate any participating physician who specializes in pediatrics as the child’s primary care provider if the provider is available to accept the child.    (c)    (1)    (i)    This subsection applies only to a carrier that:                1.    provides coverage for obstetrical or gynecological care; and                2.    requires the designation by an insured individual of a participating primary care provider.            (ii)    This subsection may not be construed to:                1.    waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of obstetrical or gynecological care; or                2.    prohibit a carrier from requiring that the obstetrical or gynecological provider notify the primary care provider or carrier for an insured individual of treatment decisions.        (2)    A carrier shall treat the provision of obstetrical and gynecological care and the ordering of related obstetrical and gynecological items and services by a participating health care provider that specializes in obstetrics or gynecology as care authorized by the primary care provider for the insured individual.        (3)    A carrier may not require authorization or referral by any person, including the primary care provider for the insured individual, for an insured individual who seeks coverage for obstetrical or gynecological care provided by a participating health care provider who specializes in obstetrics or gynecology.        (4)    A health care provider that provides obstetrical or gynecological care shall comply with a carrier’s policies and procedures.
MD. Insurance Code Ann. §  15-1A-16 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-16 - Acceptable Medical Loss Ratio -- Calculation

    (a)    (1)    For purposes of this section, “medical loss ratio”:            (i)    has the meaning established in 45 C.F.R. § 158.221; or            (ii)    if the Commissioner adopts regulations as described in paragraph (2) of this subsection, has the meaning established by the adopted regulations.        (2)    To the extent necessary, the Commissioner shall adopt regulations that:            (i)    establish a definition for “medical loss ratio”; and            (ii)    are consistent with 45 C.F.R. § 158.221 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.    (b)    This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan.    (c)    The minimum acceptable medical loss ratio is:        (1)    for the large group market, 85% or a higher percentage as determined by the Commissioner in regulations; and        (2)    for the small group market and individual market, 80% or a higher percentage as determined by the Commissioner in regulations.    (d)    (1)    Except as provided in paragraph (2) of this subsection, each carrier shall comply with the requirements for calculating medical loss ratios and related reporting and rebate requirements established in 45 C.F.R. Part 158 and any corresponding federal rules and guidance.        (2)    If the Commissioner adopts regulations as described in subsection (e) of this section, each carrier shall comply with the requirements in the adopted regulations.    (e)    To the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish requirements for calculating medical loss ratios and related reporting and rebate requirements; and        (2)    are consistent with 45 C.F.R. Part 158 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
MD. Insurance Code Ann. §  15-1A-17 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-17 - Required Information Provided by Carrier -- Disclosures -- Hardship Exemptions -- Catastrophic Plans

    (a)    (1)    This section may not be construed to require a carrier to disclose information that is proprietary and trade secret information under applicable law.        (2)    This section applies only to carriers offering an individual plan or a small group plan.    (b)    A carrier shall disclose to an individual or employer, as applicable, the following information:        (1)    the carrier’s right to change premium rates and the factors that may affect changes in premium rates; and        (2)    the benefits and premiums available under all health benefit plans for which the employer or individual is qualified.    (c)    The carrier shall make the disclosure required under subsection (b) of this section:        (1)    as part of its solicitation and sales material; or        (2)    if the information is requested by the individual or employer.    (d)    Information disclosed in accordance with subsection (b) of this section shall be:        (1)    provided in a manner determined to be understandable by the average employer or individual; and        (2)    sufficient to reasonably inform the employer or individual of the employer’s or individual’s rights and obligations under the health benefit plan.
MD. Insurance Code Ann. §  15-1A-18 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-18 - Catastrophic Plans -- Regulations Governing

    (a)    A carrier may offer a catastrophic plan in the individual market in accordance with the requirements of this section.    (b)    A catastrophic plan may be offered only to individuals who:        (1)    are under the age of 30 years before the beginning of the plan year; or        (2)    hold certification for a hardship exemption or an affordability exemption as required in subsection (c) of this section.    (c)    (1)    Except as provided in paragraph (2) of this subsection, to be offered a catastrophic plan, an individual shall hold certification for a hardship exemption or an affordability exemption under 42 U.S.C. § 5000A.        (2)    If the Maryland Health Benefit Exchange adopts regulations as described under subsection (d) of this section, an individual shall hold certification for a hardship exemption or an affordability exemption under the regulations adopted by the Exchange.    (d)    To the extent necessary, the Maryland Health Benefit Exchange shall adopt regulations that:        (1)    establish a process for issuing hardship exemptions and affordability exemptions; and        (2)    are consistent with 42 U.S.C. § 5000A and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.    (e)    (1)    Subject to paragraph (2) of this subsection, a catastrophic plan shall provide coverage for essential health benefits.        (2)    A catastrophic plan shall require a deductible that:            (i)    is equal to the annual limit on cost–sharing described in § 15–1A–19 of this subtitle;            (ii)    applies to essential health benefits;            (iii)    does not apply to at least three primary care visits each plan year; and            (iv)    does not apply to any covered benefits for which a deductible is prohibited under this title.
MD. Insurance Code Ann. §  15-1A-19 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-19 - Annual Limitations on Cost Sharing for Essential Health Benefits Covered -- Regulations

    (a)    (1)    In this section, “cost–sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits.        (2)    “Cost–sharing” includes:            (i)    deductibles, coinsurance, copayments, or similar charges; and            (ii)    any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to essential health benefits covered under the plan.        (3)    “Cost–sharing” does not include premiums, balance billing amounts for nonnetwork providers, or spending for noncovered services.    (b)    (1)    Except as provided in paragraph (2) of this subsection, each carrier shall comply with annual limitations on cost–sharing for essential health benefits covered under health benefit plans as established by 45 C.F.R. § 156.130.        (2)    If the Commissioner adopts regulations as described in subsection (c) of this section, each carrier shall comply with the adopted regulations.    (c)    To the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish annual limitations on cost–sharing; and        (2)    are consistent with 45 C.F.R. § 156.130 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
MD. Insurance Code Ann. §  15-1A-20 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-20 - Prescription Drug Essential Health Benefits for Individual and Small Group Plans

    (a)    (1)    This section applies only to individual plans and small group plans.        (2)    The requirements in this section are in addition to and not in substitution of any other requirements of law related to prescription drug benefits.    (b)    (1)    Except as provided in paragraph (2) of this subsection, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with 45 C.F.R. § 156.122.        (2)    If the Commissioner adopts regulations as described in subsection (c) of this section, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with the regulations adopted by the Commissioner.    (c)    To the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish criteria to determine whether an individual plan or a small group plan provides prescription drug essential health benefit coverage; and        (2)    are consistent with 45 C.F.R. § 156.122 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
MD. Insurance Code Ann. §  15-1A-21 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-21 - Rescission of Coverage Under Health Benefit Plans -- Exceptions

    (a)    This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan.    (b)    (1)    Subject to § 15–1106 of this title, a carrier may not rescind the coverage under a health benefit plan unless:            (i)    the insured individual performs an act, a practice, or an omission that constitutes fraud or makes a misrepresentation of material fact as prohibited by the health benefit plan; and            (ii)    except as provided in paragraph (2) of this subsection, the carrier complies with 45 C.F.R. § 147.128.        (2)    If the Commissioner adopts regulations as described in subsection (c) of this section, a carrier that rescinds the coverage under a health benefit plan in accordance with subsection (b) of this section shall comply with the adopted regulations.    (c)    To the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish requirements that a carrier shall comply with to rescind coverage under subsection (b) of this section; and        (2)    are consistent with 45 C.F.R. § 147.128 and any federal rules and guidance as those provisions were in effect December 1, 2019.
MD. Insurance Code Ann. §  15-1A-22 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-22 - Carriers May Refuse or Deny Coverage for Non-Discriminatory Reasons -- Discrimination Based on Sexual Orientation or Gender Identity Prohibited

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Gender identity” has the meaning stated in § 20–101 of the State Government Article.        (3)    “Sexual orientation” has the meaning stated in § 20–101 of the State Government Article.    (b)    This section does not prohibit a carrier from refusing, withholding, or denying coverage under a health benefit plan to any individual for failure to conform to the usual and regular requirements, standards, and regulations of the carrier, unless the denial is based on discrimination on the grounds of race, sex, color, creed, national origin, marital status, sexual orientation, age, gender identity, or disability.    (c)    This section does not apply to limitations or restrictions related to age or marital status that are specifically authorized or required under this article to limit or restrict eligibility for insurance coverage or benefits.    (d)    A carrier may not refuse, withhold, or deny any individual coverage under a health benefit plan offered by the carrier or otherwise discriminate against any individual because of the individual’s race, sex, creed, color, national origin, marital status, sexual orientation, age, gender identity, or disability.    (e)    The Commission on Civil Rights shall enforce the provisions of this section as provided for in § 2–202 of this article.
MD. Insurance Code Ann. §  15-202 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-202 - Language and Order of Policy Provisions

    (a)    Except as otherwise provided in this section, each policy of health insurance that is delivered or issued for delivery in the State:        (1)    shall contain the exact language of each provision that is required under §§ 15-207 through 15-218 of this subtitle and any optional provision in §§ 15-207 through 15-226 of this subtitle that is used; and        (2)    shall contain each mandatory provision and any optional provision that is used:            (i)    in the order in which those provisions appear in this subtitle; or            (ii)    as individual items in any part of the policy with other provisions to which they may be logically related, if the resulting policy is not wholly or partly unintelligible, uncertain, or likely to mislead a person to whom the policy is offered, delivered, or issued.    (b)    The insurer may substitute a corresponding provision with different wording for a provision set forth in this subtitle if the corresponding provision is approved by the Commissioner and is not less favorable in any respect to the insured or beneficiary.    (c)    If a provision specified in §§ 15-207 through 15-218 of this subtitle is wholly or partly inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the Commissioner, shall:        (1)    omit from the policy the inapplicable provision or part of the provision; or        (2)    modify the inconsistent provision or part of the provision to make it consistent with the coverage provided by the policy.    (d)    Each provision shall be preceded individually by the applicable caption shown or, at the option of the insurer, by an appropriate individual or group caption or subcaption that the Commissioner approves.
MD. Insurance Code Ann. §  15-203 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-203 - Right to Refuse Renewal

    Other than a policy of accident only insurance, each policy of health insurance in which the insurer reserves the right to refuse renewal on an individual basis shall contain a provision, endorsement, or rider that provides in substance:         (1)    that, subject to the right to terminate the policy on nonpayment of premium when due, the right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the policy;        (2)    that a refusal to renew shall be without prejudice to any claim that originates while the policy is in effect;        (3)    that a renewal may not be refused solely because of a change in the health or physical or mental condition of the insured; and        (4)    unless omitted at the insurer’s option, that the right to refuse renewal of a policy of health insurance that was reinstated after lapse may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement.
MD. Insurance Code Ann. §  15-204 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-204 - Age Limit; Misstatement of Age

    (a)    If a policy of health insurance establishes, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and the date falls within a period for which the insurer accepts a premium for the policy, or if the insurer accepts a premium for the policy after that date, the coverage provided by the policy continues in effect until the end of the period for which the insurer has accepted the premium.    (b)    If the age of the insured is misstated and, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased before the acceptance of a premium for the policy, the liability of the insurer is limited to the refund, on request, of the premiums paid for the period not covered by the policy.
MD. Insurance Code Ann. §  15-205 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-205 - Policies of Foreign or Alien Insurers; Policies of Domestic Insurers

    (a)    A policy of a foreign insurer or alien insurer that is delivered or issued for delivery in the State may contain a provision that:        (1)    is not less favorable to the insured or beneficiary than the provisions of this subtitle; and        (2)    is required by the law of the state or country under which the foreign insurer or alien insurer is organized.    (b)    A policy of a domestic insurer that is issued for delivery in another state or country may contain a provision that is allowed or required by the laws of the other state or country.
MD. Insurance Code Ann. §  15-206 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-206 - Policies and Provisions at Variance With Subtitle

    (a)    A policy provision that is not subject to this subtitle may not make the policy or any part of the policy less favorable in any respect to the insured or beneficiary than the provisions of the policy that are subject to this subtitle.    (b)    A policy that is delivered or issued for delivery in the State in violation of this subtitle is valid but shall be construed as provided in this subtitle.    (c)    Whenever a policy provision that is subject to this subtitle conflicts with a provision of this subtitle, the rights, duties, and obligations of the insurer, insured, and beneficiary shall be governed by this subtitle.
MD. Insurance Code Ann. §  15-207 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-207 - Entire Contract; Changes

    Each policy of health insurance shall contain the following provision:    “Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No insurance producer has authority to change this policy or to waive any of its provisions.”
MD. Insurance Code Ann. §  15-208 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 2 - Individual Health Insurance Policy Forms and Provisions|Section 15-208 - Time Limit on Specified Defenses

    (a)    Except as provided in subsection (c) of this section, each policy of health insurance shall contain the following provision:    “Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such two-year period.”        (2)    “No claim for loss incurred or disability (as defined in the policy) commencing after two years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.”    (b)    The first provision set forth in subsection (a) of this section does not:        (1)    affect a legal requirement for avoidance of a policy or denial of a claim during the initial two-year period after the issuance of the policy; or        (2)    limit the application of §§ 15-219 through 15-223 of this subtitle if there is a misstatement with respect to age, occupation, or other insurance.    (c)    (1)    This subsection applies only to a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:            (i)    until the insured is at least 50 years old; or            (ii)    if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.        (2)    A policy subject to this subsection may omit the first provision set forth in subsection (a) of this section and substitute the following provision under the caption “incontestable”:    “After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.”        (3)    In the provision set forth in paragraph (2) of this subsection, an insurer may omit the clause “excluding any period during which the insured is disabled”.