reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-145 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-145 - Definitions -- When Health Savings Account Established

    (a)    (1)    In this section the following words having the meanings indicated.        (2)    “Health savings account” has the meaning stated in § 223 of the Internal Revenue Code.        (3)    “High deductible health plan” has the meaning stated in § 223 of the Internal Revenue Code.    (b)    A health savings account is established on the first day that an individual becomes covered by a high deductible health plan.    (c)    The health savings account shall be opened with a trustee or custodian within the time period prescribed by law, without extensions, for filing a federal income tax return for the year in which the health savings account is established.    (d)    A health savings account is established regardless of a transfer of cash or other property to the account and, unless required by the trustee or custodian, it is not necessary for any party to sign a health savings account trust or custodial agreement regarding the health savings account.
MD. Insurance Code Ann. §  15-1A-01 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-01 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Carrier” means:        (1)    an insurer that holds a certificate of authority in the State and provides health insurance in the State;        (2)    a health maintenance organization that is licensed to operate in the State;        (3)    a nonprofit health service plan that is licensed to operate in the State; or        (4)    any other person or organization that provides health benefit plans subject to State insurance regulation.    (c)    “Child” means:        (1)    a natural child, a stepchild, a foster child, or an adopted child of the insured; or        (2)    a child placed with the insured for legal adoption.    (d)    “Essential health benefit” means a health benefit that:        (1)    meets the criteria established under § 1302(b) of the Affordable Care Act; or        (2)    if the Commissioner adopts regulations as described in § 15–1A–04 of this subtitle, meets the criteria established by the adopted regulations.    (e)    “Grandfathered plan” means a health benefit plan that:        (1)    meets the criteria established under 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019; or        (2)    if the Commissioner adopts regulations as described in § 15–1A–03 of the subtitle, meets the criteria established by the adopted regulations.    (f)    “Group plan” means a small group plan or a large group plan.    (g)    “Health benefit plan” means an individual plan, a small group plan, or a large group plan.    (h)    “Individual plan” means an individual health benefit plan as defined in § 15–1301(o) of this title.    (i)    “Insured individual” means:        (1)    an insured, an enrollee, a subscriber, a participant, a member, or a beneficiary of a health benefit plan; or        (2)    any covered dependent of a health benefit plan.    (j)    “Large group plan” means a health benefit plan as defined in § 15–1401 of this title.    (k)    “Small group plan” means a health benefit plan as defined in § 15–1201 of this title.
MD. Insurance Code Ann. §  15-1A-02 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-02 - Enforcement of Provisions by Commissioner

    (a)    The Commissioner may enforce:        (1)    the provisions of this subtitle; and        (2)    notwithstanding any other provisions of law, the following provisions of Title 1, Subtitles A, C, and D of the Affordable Care Act as they apply to individual health insurance coverage and health insurance coverage offered in the small group and large group markets as those terms are defined in the federal Public Health Service Act, issued or delivered in the State by an authorized insurer, nonprofit health service plan, or health maintenance organization:            (i)    coverage of children up to the age of 26 years;            (ii)    preexisting condition exclusions;            (iii)    policy rescissions;            (iv)    bona fide wellness programs;            (v)    lifetime limits;            (vi)    annual limits for essential benefits;            (vii)    waiting periods;            (viii)    designation of primary care providers;            (ix)    access to obstetrical and gynecological services;            (x)    emergency services;            (xi)    summary of benefits and coverage explanation;            (xii)    minimum loss ratio requirements and premium rebates;            (xiii)    disclosure of information;            (xiv)    annual limitations on cost–sharing;            (xv)    child–only plan offerings in the individual market;            (xvi)    minimum benefit requirements for catastrophic plans;            (xvii)    health insurance premium rates;            (xviii)    coverage for individuals participating in approved clinical trials;            (xix)    contract requirements for stand–alone dental plans sold on the Maryland Health Benefit Exchange;            (xx)    guaranteed availability of coverage;            (xxi)    prescription drug benefit requirements; and            (xxii)    preventive and wellness services and chronic disease management.    (b)    The Commissioner may enforce the provisions identified under subsection (a) of this section under any applicable powers granted to the Commissioner under this article.
MD. Insurance Code Ann. §  15-1A-03 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-03 - Adoption of Regulations -- Application to Health Benefit Plan -- Grandfathered Plans

    (a)    For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish criteria that a health benefit plan must meet to be considered a grandfathered plan; and        (2)    are consistent with 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.    (b)    Except as otherwise provided in this subtitle and subject to subsection (c) of this section, this subtitle applies to any health benefit plan that is offered by a carrier in the State within the scope of:        (1)    Subtitle 12 of this title;        (2)    Subtitle 13 of this title; or        (3)    Subtitle 14 of this title.    (c)    (1)    Except as provided in paragraph (2) of this subsection, the provisions of this subtitle do not apply to a grandfathered plan.        (2)    (i)    The following provisions apply to all grandfathered plans:                1.    the provisions of § 15–1A–08 of this subtitle related to health benefit plans that provide dependent coverage of a child;                2.    the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing lifetime limits on the dollar value of benefits;                3.    the provisions of § 15–1A–12 of this subtitle related to waiting periods;                4.    the provisions of § 15–1A–15 of this subtitle related to summary of benefits and coverage requirements;                5.    the provisions of § 15–1A–16 of this subtitle related to medical loss ratio and corresponding reporting and rebate requirements; and                6.    the provisions of § 15–1A–21 of this subtitle related to rescission of a health benefit plan.            (ii)    The following provisions apply to all grandfathered plans except grandfathered plans that are individual plans:                1.    the provisions of § 15–1A–05 of this subtitle related to preexisting condition exclusions; and                2.    the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing annual limits on the dollar value of benefits.
MD. Insurance Code Ann. §  15-1A-04 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-04 - Criteria for Health Benefit Plans -- Consistent With Federal Law

    For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that:        (1)    establish criteria that a health benefit plan must meet to be considered a health benefit plan that covers essential health benefits; and        (2)    are consistent with 45 C.F.R. Part 156 Subpart B and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
MD. Insurance Code Ann. §  15-1A-05 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-05 - Application to Grandfathered Plans -- Prohibition on Certain Exclusions or Denials

    (a)    This section applies to all grandfathered plans except grandfathered plans that are individual plans and to every health benefit plan that is not a grandfathered plan.    (b)    A carrier may not:        (1)    exclude or limit benefits because a health condition was present before the effective date of coverage; or        (2)    deny coverage because a health condition was present before or on the date of denial.    (c)    The prohibition in subsection (b) of this section applies whether or not:        (1)    any medical advice, diagnosis, care, or treatment was recommended or received for the condition; or        (2)    the health condition was identified as a result of:            (i)    a pre–enrollment questionnaire or physical examination given to an individual; or            (ii)    a review of records relating to the pre–enrollment period.
MD. Insurance Code Ann. §  15-1A-06 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-06 - Certain Factors Prohibited in Consideration -- Extra Premiums Prohibited

    (a)    A carrier may not establish rules for eligibility, including continued eligibility, for enrollment of an individual into a health benefit plan based on health status–related factors, including:        (1)    health condition;        (2)    claims experience;        (3)    receipt of health care;        (4)    medical history;        (5)    genetic information;        (6)    evidence of insurability including conditions arising out of acts of domestic violence; or        (7)    disability.    (b)    A carrier may not require an individual, as a condition of enrollment or continued enrollment in a health benefit plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the health benefit plan on the basis of any health status–related factor in relation to the individual or to an individual enrolled under the health benefit plan as a dependent of the individual.
MD. Insurance Code Ann. §  15-1A-07 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-07 - Premium Rates Review -- Basis -- Ratio of Premium Rate Variation

    (a)    (1)    This section may not be construed to limit the authority of the Commissioner to conduct a health benefit plan premium rate review under Title 11, Subtitle 6 of this article.        (2)    This section applies only to a carrier offering an individual plan and, subject to § 15–1205 of this title, a carrier offering a small group plan.    (b)    A carrier may determine a premium rate based on:        (1)    subject to subsection (c) of this section, age;        (2)    geography based on the following contiguous areas of the State:            (i)    the Baltimore metropolitan area;            (ii)    the District of Columbia metropolitan area;            (iii)    Western Maryland; and            (iv)    Eastern Maryland and Southern Maryland;        (3)    subject to subsection (d) of this section, whether the plan covers an individual or a family; and        (4)    subject to subsection (e) of this section, tobacco use.    (c)    (1)    In this subsection, “age” means an individual’s age as of the date of issuance or renewal of a health benefit plan.        (2)    For individuals who are 21 years of age or older, a premium rate based on age:            (i)    may not vary by more than a ratio of 3 to 1 for adults;            (ii)    shall provide for 1–year age bands for individuals at least 21 years old and under the age of 64 years; and            (iii)    shall provide for a single age band for individuals at least 64 years old.        (3)    For individuals who are under the age of 21 years, a premium rate based on age shall:            (i)    be actuarially justified and consistent with the uniform age rating curve established in accordance with paragraph (4) of this subsection;            (ii)    provide for a single age band for individuals under the age of 15 years; and            (iii)    provide for 1–year age bands for individuals at least 15 years old and under the age of 20 years.        (4)    The uniform age rating curve required under paragraph (3)(i) of this subsection may be established by the Commissioner in the individual market, small group market, or both markets.    (d)    (1)    A rating variation for a health benefit plan that provides coverage for a family shall be applied based on the portion of the premium attributable to each family member covered.        (2)    (i)    Subject to subparagraph (ii) of this paragraph, a premium for a health benefit plan that provides coverage for a family shall be determined by summing the premiums for each individual family member.            (ii)    For a health benefit plan that provides family coverage for individuals under the age of 21 years, the sum shall include not more than the premiums for the three oldest individuals under the age of 21 years.    (e)    A premium rate based on tobacco use may not vary by more than a ratio of 1.5 to 1.
MD. Insurance Code Ann. §  15-1A-08 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-08 - Coverage Available for Dependent Child Until Age of 26 Years -- Relationship to Insured

    (a)    A carrier that offers a health benefit plan, including a grandfathered plan, that provides for dependent coverage of a child shall continue to make the coverage available for the child until the child is 26 years old.    (b)    A carrier may not establish rules for eligibility, including continued eligibility, for coverage of a child under the age of 26 years based on any factor other than the relationship between the child and the insured.
MD. Insurance Code Ann. §  15-1A-09 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-09 - Acceptance of All Employers and Individuals -- Exceptions

    (a)    Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article:        (1)    Subtitle 4 of this title;        (2)    §§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title;        (3)    §§ 15–1316 and 15–1318 of this title; and        (4)    §§ 15–1406 and 15–1406.1 of this title.    (b)    (1)    Except as provided in paragraph (2) of this subsection, a carrier may restrict enrollment to open or special enrollment periods.        (2)    A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year.    (c)    If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier:        (1)    (i)    may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and            (ii)    if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or        (2)    may deny coverage within a service area if the carrier:            (i)    demonstrates to the Commissioner that:                1.    the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and                2.    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and            (ii)    does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area.    (d)    A carrier may deny coverage if the carrier:        (1)    demonstrates to the Commissioner that:            (i)    the carrier does not have the financial reserves necessary to underwrite additional coverage; and            (ii)    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and        (2)    unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.
MD. Insurance Code Ann. §  15-1A-10 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-10 - Coverages Required and Additional Charges Prohibited -- Out-of-Network Charges -- Services Recommended or Not by Task Force

    (a)    Except as provided in subsections (b) and (c) of this section, a carrier shall provide coverage for and may not impose any cost–sharing requirements, including copayments, coinsurance, or deductibles for:        (1)    evidence–based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force with respect to the individual involved;        (2)    immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved, if the recommendation:            (i)    has been adopted by the Director of the Centers for Disease Control and Prevention; and            (ii)    is listed on the Immunization Schedules of the Centers for Disease Control and Prevention for routine use;        (3)    with respect to infants, children, and adolescents, evidence–informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and        (4)    with respect to women:            (i)    to the extent not provided in item (ii) of this item, preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of § 2713(a)(4) of the federal Public Health Service Act; and            (ii)    subject to  § 15–826(c) of this title, contraceptive coverage as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of § 2713(a)(4) of the federal Public Health Service Act.    (b)    To the extent that cost–sharing is otherwise allowed under federal or State law, a health benefit plan that uses a network of providers may impose cost–sharing requirements on the coverage described in subsection (a) of this section for items or services delivered by an out–of–network provider.    (c)    This section may not be construed to prohibit a carrier from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.
MD. Insurance Code Ann. §  15-1A-11 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-11 - Lifetime or Annual Limits on Benefits

    (a)    Except as provided in subsections (b) and (c) of this section, a carrier that offers a health benefit plan, including a grandfathered plan, may not establish lifetime limits or annual limits on the dollar value of benefits for any insured individual.    (b)    To the extent that limits are otherwise authorized under federal or State law, a carrier may establish annual limits on the dollar value of benefits for an insured individual for a grandfathered plan that is an individual plan.    (c)    This section may not be construed to prohibit a carrier from placing annual or lifetime per beneficiary limits on specific covered benefits that are not essential health benefits.
MD. Insurance Code Ann. §  15-1A-12 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1A - Consumer Protections|Section 15-1A-12 - Limit on Waiting Period for Otherwise Eligible Individual

    A carrier offering a group plan, including a grandfathered plan, may not apply a waiting period of more than 90 days that must pass before coverage becomes effective for an individual who is otherwise eligible for the group plan.