reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-849 - Coverage for Abuse-Deterrent Opioid Analgesic Drug Products

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Abuse–deterrent opioid analgesic drug product” means a brand name or generic opioid analgesic drug product approved by the U.S. Food and Drug Administration with abuse–deterrent labeling that indicates the drug product is expected to result in a meaningful reduction in abuse.
(3)    “Opioid analgesic drug product” means a drug product that contains an opioid agonist and is indicated by the U.S. Food and Drug Administration for the treatment of pain, regardless of whether the drug product:
(i)    is in immediate release or extended release form; or
(ii)    contains other drug substances.
(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)    (1)    An entity subject to this section shall provide coverage for:
(i)    at least two brand name abuse–deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for brand name prescription drugs on the entity’s formulary for prescription drug coverage; and
(ii)    if available, at least two generic abuse–deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for generic drugs on the entity’s formulary for prescription drug coverage.
(2)    An entity subject to this section may not require an insured or an enrollee to first use an opioid analgesic drug product without abuse–deterrent labeling before providing coverage for an abuse–deterrent opioid analgesic drug product covered on the entity’s formulary for prescription drug coverage.
(d)    Notwithstanding subsection (c)(2) of this section, an entity subject to this section may undertake utilization review, including preauthorization, for an abuse–deterrent opioid analgesic drug product covered by the entity, if the same utilization review requirements are applied to non–abuse–deterrent opioid analgesic drug products covered by the entity in the same formulary tier as the abuse–deterrent opioid analgesic product.
2023 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.
2023 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.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-852 - Prorated Daily Copayment or Coinsurance Amount for Partial Supply of Prescription Drug

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “In–network pharmacy” means a pharmacy that is among the participating providers with which an entity subject to this section contracts to provide health care services to members.
(3)    “Member” means an individual entitled to health care benefits for prescription drugs or devices under a policy issued or delivered in the State by an entity subject to this section.
(b)    (1)    This section applies to:
(i)    insurers and nonprofit health service plans that provide coverage for prescription drugs and devices under health insurance policies or contracts that are issued or delivered in the State; and
(ii)    health maintenance organizations that provide coverage for prescription drugs and devices under 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 and devices through a pharmacy benefits manager is subject to the requirements of this section.
(c)    An entity subject to this section shall allow and apply a prorated daily copayment or coinsurance amount for a partial supply of a prescription drug dispensed by an in–network pharmacy if:
(1)    the prescriber or the pharmacist determines dispensing a partial supply of a prescription drug to be in the best interest of the member;
(2)    the prescription drug is anticipated to be required for more than 3 months;
(3)    the member requests or agrees to a partial supply for the purpose of synchronizing the dispensing of the member’s prescription drugs;
(4)    the prescription drug is not a Schedule II controlled dangerous substance; and
(5)    the supply and dispensing of the prescription drug meets all prior authorization and utilization management requirements specific to the prescription drug at the time of the synchronized dispensing.
(d)    Subject to subsection (c) of this section, an entity subject to this section:
(1)    may not deny payment of benefits to an in–network pharmacy for a covered prescription drug solely on the basis that only a partial supply of the prescription drug was dispensed; and
(2)    shall allow an in–network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.
(e)    Subject to subsection (c) of this section, an entity subject to this section:
(1)    may not use a payment structure that incorporates prorated dispensing fees for dispensing a partial supply of a prescription drug; and
(2)    shall pay an in–network pharmacy a full dispensing fee for dispensing a partial supply of a prescription drug under this section, regardless of:
(i)    any prorated copayment or coinsurance amount charged to a member; or
(ii)    any fee paid to the pharmacy for synchronizing a member’s prescriptions.
2023 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.
2023 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)    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.
(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.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-856 - Coverage for Costs of Covid-19 Tests and Related Items and Services Â Copayment, Coinsurance Requirements, and Deductible Coverage Prohibited. [Abrogated]

// EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND 31  OF 2021 SPECIAL SESSION //
(a)    (1)    In this section the following words have the meanings indicated.
(2)    “COVID–19” means, interchangeably and collectively, the coronavirus known as COVID–19 or 2019–nCoV and the SARS–CoV–2 virus.
(3)    (i)    “COVID–19 test” means an in vitro diagnostic test for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, as described in § 3201 of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.
(ii)    “COVID–19 test” includes a federal Food and Drug Administration–approved, cleared, or authorized rapid point–of–care test and an at–home collection test for the detection or diagnosis of COVID–19.
(4)    “Health benefit plan”:
(i)    for a small employer plan, has the meaning stated in § 15–1201 of this title; and
(ii)    for an individual plan, has the meaning stated in § 15–1301 of this title.
(5)    (i)    “Member” means an individual entitled to health care benefits under a policy issued or delivered in the State by an entity subject to this section.
(ii)    “Member” includes a subscriber.
(b)    (1)    This section applies to:
(i)    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
(ii)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(2)    This section applies to each individual and small employer health benefit plan that is issued or delivered in the State by an insurer, a nonprofit health service plan, or a health maintenance organization, irrespective of §§ 15–1207(d) and 31–116 of this article.
(c)    An entity subject to this section shall provide coverage for COVID–19 tests and related items and services for the administration of COVID–19 tests, including facility fees, health care practitioner fees, and evaluation of the member for purposes of determining the need for the COVID–19 test, as required by the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and any applicable federal regulations or guidance.
(d)    An entity subject to this section may not apply a copayment, coinsurance requirement, or deductible to coverage for COVID–19 tests and related items and services for the administration of COVID–19 tests.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-857 - Coverage for Abortion Care Services

(a)    (1)    This section applies to:
(i)    insurers and nonprofit health service plans that provide labor and delivery coverage to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
(ii)    health maintenance organizations that provide labor and delivery coverage to individuals or groups under contracts that are issued or delivered in the State.
(2)    This section does not apply to:
(i)    a multistate plan that does not provide coverage for abortions in accordance with 42 U.S.C. § 18054(a)(6); or
(ii)    a high–deductible plan, as defined in 26 U.S.C. § 223(c)(2)(C) of the Internal Revenue Code, unless the Commissioner determines that abortion care is not excluded from the safe harbor provisions for preventive care under § 223(c)(2)(C) of the Internal Revenue Code.
(3)    An organization that is eligible to obtain an exclusion from the coverage requirements under § 15–826 of this subtitle may obtain from an entity subject to this section an exclusion from the coverage and notice requirements of this section if the requirements conflict with the organization’s bona fide religious beliefs and practices.
(b)    Except as provided in subsection (c) of this section, an entity subject to this section shall:
(1)    cover abortion care services without:
(i)    a deductible, coinsurance, copayment, or any other cost–sharing requirement; and
(ii)    restrictions that are inconsistent with the protected rights under Title 20, Subtitle 2 of the Health – General Article; and
(2)    provide information to consumers about abortion care coverage using the terminology “abortion care” to describe coverage.
(c)    If the Commissioner determines that enforcement of this section may adversely affect the allocation of federal funds to the State, the Commissioner may grant an exemption to the requirements of this section to the minimum extent necessary to ensure the continued receipt of federal funds.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 8 - Required Health Insurance Benefits › Section 15-858 - Coverage for Prescription Drugs for Hiv Prevention

(a)    (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.
(b)    An entity subject to this section may not apply a prior authorization requirement for a prescription drug used as postexposure prophylaxis for the prevention of HIV if the prescription drug is prescribed for use in accordance with Centers for Disease Control and Prevention guidelines.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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”.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.