reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-850 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-850 - Prior Authorizations for Opioid Antagonist

    (a)    In this section, “opioid antagonist” means:        (1)    naloxone hydrochloride; or        (2)    any other similarly acting and equally safe drug approved by the federal Food and Drug Administration for the treatment of a drug overdose.    (b)    (1)    This section applies to:            (i)    insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and            (ii)    health maintenance organizations that provide coverage for prescription drugs under individual or group contracts that are issued or delivered in the State.        (2)    An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs through a pharmacy benefits manager is subject to the requirements of this section.    (c)    An entity subject to this section that includes on its formulary an opioid antagonist may apply a prior authorization requirement for an opioid antagonist only if the entity provides coverage for at least one formulation of the opioid antagonist without a prior authorization requirement.
MD. Insurance Code Ann. §  15-851 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-851 - Prior Authorization for Drug Products to Treat Opioid Use Disorder -- Prohibition

    (a)    (1)    This section applies to:            (i)    insurers and nonprofit health service plans that provide coverage for substance use disorder benefits or prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and            (ii)    health maintenance organizations that provide coverage for substance use disorder benefits or prescription drugs under individual or group contracts that are issued or delivered in the State.        (2)    An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for substance use disorder benefits under the medical benefit or for prescription drugs through a pharmacy benefits manager is subject to the requirements of this section.    (b)    An entity subject to this section may not apply a prior authorization requirement for a prescription drug:        (1)    when used for treatment of an opioid use disorder; and        (2)    that contains methadone, buprenorphine, or naltrexone.
MD. Insurance Code Ann. §  15-853 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-853 - Coverage for Lymphedema Diagnosis, Evaluation, and Treatment

    (a)    (1)    In this section, “gradient compression garment” means a garment that:            (i)    is used for the treatment of lymphedema;            (ii)    requires a prescription; and            (iii)    is custom fit for the individual for whom the garment is prescribed.        (2)    “Gradient compression garment” does not include disposable medical supplies, including over–the–counter compression or elastic knee–high or other stocking products.    (b)    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.    (c)    An entity subject to this section shall provide coverage for the medically necessary diagnosis, evaluation, and treatment of lymphedema, including equipment, supplies, complex decongestive therapy, gradient compression garments, and self–management training and education.    (d)    (1)    Subject to paragraph (2) of this subsection, the coverage required under this section may be subject to the annual deductibles, copayments, or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract.        (2)    The annual deductibles, copayments, or coinsurance requirements imposed under paragraph (1) of this subsection for the coverage required under this section may not be greater than the annual deductibles, copayments, or coinsurance requirements imposed by the entity for similar coverages.
MD. Insurance Code Ann. §  15-855 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 8 - Required Health Insurance Benefits|Section 15-855 - Coverage for Pediatric Autoimmune Neuropsychiatric Disorders

    (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)    (1)    Except as provided for in paragraph (2) of this subsection, an entity subject to this section shall provide coverage for medically necessary diagnosis, evaluation, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy.        (2)    This subsection does not require coverage for rituximab unless the federal Food and Drug Administration approves the use of rituximab for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.    (c)    (1)    Subject to paragraph (2) of this subsection, the coverage required under this section may be subject to the annual deductibles, copayments, or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract.        (2)    The annual deductibles, copayments, or coinsurance requirements imposed under paragraph (1) of this subsection for the coverage required under this section may not be greater than the annual deductibles, copayments, or coinsurance requirements imposed by the entity for similar coverages.    (d)    (1)    Except as provided for in paragraph (2) of this subsection, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis for billing and diagnosis purposes.        (2)    If the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute onset neuropsychiatric syndrome for billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as:            (i)    autoimmune encephalitis;            (ii)    pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; or            (iii)    pediatric acute onset neuropsychiatric syndrome.
MD. Insurance Code Ann. §  15-901 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-901 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Applicant” means:        (1)    for an individual Medicare supplement policy or subscriber contract, the individual who seeks to contract for insurance benefits; or        (2)    for a group Medicare supplement policy or subscriber contract, the proposed certificate holder.    (c)    “Carrier” means an insurer, nonprofit health service plan, or fraternal benefit society that is authorized to issue health insurance policies under this article.    (d)    “Certificate” means a certificate that is delivered or issued for delivery in the State under a group Medicare supplement policy.    (e)    “Certificate form” means the form on which the certificate is delivered or issued for delivery in the State by the carrier.    (f)    “CMS” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.    (g)    “Medicaid” means the Health Insurance for the Aged Act, Title XIX of the Social Security Amendments of 1965, as amended.    (h)    “Medicare” means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as amended.    (i)    “Medicare benefit period” means the unit of time used in the Medicare Program to measure use of services and availability of benefits under Medicare Part A.    (j)    “Medicare eligible expense” means a health care expense of the kind covered by Medicare to the extent the service for which the expense was incurred is considered reasonable under Medicare rules and regulations.    (k)    (1)    “Medicare supplement policy” or “Medigap policy” means an individual or group policy of health insurance or subscriber contract that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of individuals eligible for Medicare.        (2)    “Medicare supplement policy” or “Medigap policy” does not include:            (i)    a policy that is issued pursuant to a contract under § 1876 of the federal Social Security Act, 42 U.S.C. § 1395mm; or            (ii)    a policy that is issued under a demonstration project authorized pursuant to amendments to the federal Social Security Act.    (l)    “Policy” includes:        (1)    a policy that is issued to an individual;        (2)    a certificate, as that term is used in Title 14, Subtitle 1 of this article, that is issued to an individual subscriber;        (3)    a certificate, as that term is used in Title 8, Subtitle 4 of this article, that is issued to a member of a fraternal benefit society; and        (4)    a group policy authorized to be issued under this article.    (m)    “Policy form” means the form on which the policy is delivered or issued for delivery in the State by the carrier.
MD. Insurance Code Ann. §  15-902 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-902 - Legislative Intent

    This subtitle is not intended to prohibit or apply to policies, including group conversion policies, provided to Medicare eligible individuals, if the policies are not marketed or held to be Medicare supplement policies.
MD. Insurance Code Ann. §  15-903 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-903 - Scope of Subtitle

    (a)    Notwithstanding any other provision to the contrary, this subtitle applies to:        (1)    Medicare supplement policies and subscriber contracts that are delivered or issued for delivery in the State after July 1, 1992;        (2)    certificates that are issued under group Medicare supplement policies or subscriber contracts, which certificates have been delivered or issued for delivery in the State;        (3)    individual or group Medicare supplement policies and certificates that are issued by nonprofit health service plans under Title 14, Subtitle 1 of this article;        (4)    Medicare supplement policies and certificates that are issued by fraternal benefit societies under Title 8, Subtitle 4 of this article; and        (5)    Medicare supplement group or blanket policies and certificates that are issued by insurers subject to Subtitle 3 of this title.    (b)    This subtitle does not apply to a policy of:        (1)    one or more employers or labor organizations; or        (2)    the trustees of a fund established by one or more employers or labor organizations for employees, members, former employees, or former members.    (c)    A health maintenance organization that enrolls members eligible for Medicare benefits under Title XVIII of the Social Security Act is subject to the requirements of this subtitle to the extent any of the provisions of this subtitle apply to the Medicare eligible members.
MD. Insurance Code Ann. §  15-904 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-904 - Compliance With Subtitle Required; Medicare Select Program

    (a)    A carrier may not issue, deliver, or renew a Medicare supplement policy in the State unless the Medicare supplement policy complies with this subtitle.    (b)    (1)    Notwithstanding any other provision of this subtitle, an insurer or a nonprofit health service plan that is authorized to issue Medicare supplement policies under this article may issue Medicare supplement policies under the Medicare Select Program.        (2)    The requirements for a Medicare supplement policy issued under the Medicare Select Program shall be consistent with requirements set forth in the federal Omnibus Budget Reconciliation Act of 1990 and any subsequent relevant federal law and regulations.        (3)    The Maryland Department of Health shall determine the adequacy of the network established by an insurer or a nonprofit health service plan under the Medicare Select Program, as to the number of providers, geographic location, hours of operation, promptness of service, and range of services, in the same manner as determined for a health maintenance organization under §§ 19–705.1 and 19–705.2 of the Health – General Article.    (c)    The Commissioner may adopt regulations, in consultation with the Secretary of Health, to establish the requirements of the Medicare Select Program.
MD. Insurance Code Ann. §  15-905 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-905 - Restoration of Benefits

    A carrier shall restore any benefit that was eliminated from a Medicare supplement policy because of the federal Medicare Catastrophic Coverage Act of 1988.
MD. Insurance Code Ann. §  15-906 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-906 - Policy Provisions

    (a)    A Medicare supplement policy shall provide the minimum benefits required by federal law.    (b)    (1)    For benefits designed to cover deductibles or coinsurance amounts under Medicare, a Medicare supplement policy shall provide for an automatic change in those benefits to coincide with changes in applicable Medicare deductible and copayment provisions.        (2)    Subject to approval by the Commissioner, a carrier may reserve the right in a Medicare supplement policy to change premiums to correspond with changes in benefits under paragraph (1) of this subsection.    (c)    Payment of a benefit for a Medicare eligible expense under a Medicare supplement policy may be conditioned on the same or less restrictive payment conditions that apply to a Medicare claim, including the determination of medical necessity.    (d)    (1)    Unless otherwise expressly authorized under this article or a regulation adopted by the Commissioner under this article, coverage under a Medicare supplement policy may not be subject to any exclusion, limitation, or reduction that is inconsistent with the exclusions, limitations, or reductions under Medicare.        (2)    To the extent a benefit is available to the insured under Medicare, a Medicare supplement policy shall provide that coverage for the benefit is not duplicated.    (e)    If the insured is receiving medical assistance under Medicaid, a Medicare supplement policy shall provide for the suspension of policy benefits and premiums for a maximum of 24 months.    (f)    (1)    A Medicare supplement policy, contract, or certificate in force in the State may not provide benefits that duplicate benefits provided by Medicare.        (2)    Unless approved by the Commissioner, a Medicare supplement policy may not be offered at an introductory premium rate.
MD. Insurance Code Ann. §  15-907 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-907 - Mammography Screening

    (a)    In this section, “low-dose mammography” means an x-ray examination of the breast using dedicated equipment, including an x-ray tube, filter, compression device, screens, films, and cassettes, specifically for mammography that delivers an average radiation exposure of less than one rad mid-breast with two views for each breast.    (b)    If the federal standard under § 1882(p) of the federal Social Security Act is amended to authorize the inclusion of an annual mammography screening benefit in the core group of basic benefits for Medicare supplement policies, a Medicare supplement policy shall provide for coverage for an annual screening by low-dose mammography for the presence of occult breast cancer.
MD. Insurance Code Ann. §  15-908 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-908 - Approval of Additional Benefits

    The Commissioner shall approve Medicare supplement policies that include benefits in addition to the minimum benefits listed in § 15-906(a) of this subtitle if the Medicare supplement policies and benefits:         (1)    conform with the federal Omnibus Budget Reconciliation Act of 1990 and the Medicare Supplement Insurance Minimum Standards Model Act and any regulations under the Model Act adopted by the National Association of Insurance Commissioners; and        (2)    comply with the applicable provisions of this article.
MD. Insurance Code Ann. §  15-910 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-910 - Return of Policy; Refund

    (a)    Each Medicare supplement policy or certificate shall have prominently printed on the first page of the policy or certificate or attached to it, a notice that states that the applicant may:        (1)    return the Medicare supplement policy or certificate within 30 days after its delivery; and        (2)    receive a refund of the premium if after examination of the Medicare supplement policy or certificate, the applicant is not satisfied for any reason.    (b)    The carrier shall pay a refund made under this section directly to the applicant in a timely manner.
MD. Insurance Code Ann. §  15-911 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-911 - Minimum Loss Ratio Standards for Policies

    (a)    In this section, “loss ratio” means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State.    (b)    Medicare supplement policies shall return aggregate benefits that are reasonable in relation to the premium charged.    (c)    (1)    For purposes of administering this subtitle and §§ 12-203 through 12-205 of this article, the Commissioner shall adopt reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies.        (2)    The minimum standards for loss ratios shall be based on incurred claims experience and earned premiums in accordance with accepted actuarial principles and practices and the principles and standards of the National Association of Insurance Commissioners.    (d)    The minimum acceptable loss ratios for Medicare supplement policies are:        (1)    for group Medicare supplement policies, at least 75% of the aggregate amount of premiums earned; and        (2)    for individual Medicare supplement policies or subscriber contracts that are issued or renewed on a policy anniversary after July 1, 1991, at least 65% of the aggregate amount of premiums earned.    (e)    (1)    To demonstrate compliance with the applicable minimum loss ratio standards established in the State for Medicare supplement policies, each carrier that provides Medicare supplement policies or certificates in the State shall file annually with the Commissioner the carrier’s rates, rating schedule, and supporting documentation.        (2)    Each filing of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this subtitle.    (f)    The Commissioner may require a carrier to adjust rates or give credits or refunds to policyholders of Medicare supplement policies that in practice do not meet the minimum loss ratio standards required under this section.
MD. Insurance Code Ann. §  15-912 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-912 - Specific Standards for Policy Provisions

    (a)    The Commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates.    (b)    (1)    The standards adopted by the Commissioner are in addition to and shall be in accordance with applicable laws of the State, including this title and Title 14, Subtitle 1 of this article.        (2)    No requirement of this article that relates to minimum required policy benefits, other than the minimum standards contained in this subtitle, shall apply to Medicare supplement policies and certificates.    (c)    The standards may cover, but are not limited to:        (1)    terms of renewability;        (2)    initial and subsequent conditions of eligibility;        (3)    nonduplication of coverage;        (4)    probationary periods;        (5)    benefit limitations, exceptions, and reductions;        (6)    elimination periods;        (7)    replacement requirements;        (8)    recurrent conditions;        (9)    definitions of terms; and        (10)    any other provisions required under federal Medicare law or CMS regulations.
MD. Insurance Code Ann. §  15-913 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-913 - Prohibited Policy Provisions

    The Commissioner shall adopt reasonable regulations that specify prohibited policy provisions, not otherwise specifically authorized by statute, that in the opinion of the Commissioner are unjust, unfair, or unfairly discriminatory to any individual insured or proposed to be insured under a Medicare supplement policy or certificate.
MD. Insurance Code Ann. §  15-914 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 9 - Medicare Supplement Act|Section 15-914 - Other Minimum Standards

    The Commissioner shall adopt reasonable regulations to establish minimum standards for benefits, claim payments, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.