reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-220 - Misstatement of Age

A policy of health insurance may contain the following provision:
“Misstatement of age: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-221 - Other Insurance With Insurer

(a)    A policy of health insurance may contain the following provision:
“Other insurance in this insurer: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for ........ (insert type of coverage or coverages) in excess of $ ........ (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate.”
(b)    A policy of health insurance may substitute the following provision for the provision set forth in subsection (a) of this section:
“Insurance effective at any one time on the insured under a like policy or policies in this insurer is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurer will return all premiums paid for all other such policies.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-222 - Insurance With Other Insurers -- Expense Incurred Benefits

(a)    A policy of health insurance may contain the following provision:
“Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the ‘like amount’ of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.”
(b)    The phrase “-- Expense incurred benefits” shall be added to the caption of the provision set forth in subsection (a) of this section if the provision is included in a policy that contains the policy provision set forth in § 15-223 of this subtitle.
(c)    (1)    A benefit provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute, whether provided by a governmental unit or otherwise, shall be considered “other valid coverage” of which the insurer has had notice.
(2)    The insurer may include in the provision set forth in subsection (a) of this section a definition of “other valid coverage” if the definition:
(i)    is approved as to form by the Commissioner; and
(ii)    is limited to:
1.    coverage provided by organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada;
2.    coverage provided by hospital or medical service organizations; and
3.    any other coverage that the Commissioner may approve for inclusion.
(3)    Unless defined otherwise, “other valid coverage” does not include:
(i)    group insurance or automobile medical payments insurance;
(ii)    coverage provided by hospital or medical service organizations; or
(iii)    coverage provided by union welfare plans or by employer or employee benefit organizations.
(4)    “Other valid coverage” may not include third party liability coverage.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-223 - Insurance With Other Insurers -- Other Benefits

(a)    A policy of health insurance may contain the following provision:
“Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined.”
(b)    The phrase “-- Other benefits” shall be added to the caption of the provision set forth in subsection (a) of this section if the provision is included in a policy that contains the policy provision set out in § 15-222 of this subtitle.
(c)    (1)    A benefit provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute, whether provided by a governmental unit or otherwise, shall be considered “other valid coverage” of which the insurer has had notice.
(2)    The insurer may include in the provision set forth in subsection (a) of this section a definition of “other valid coverage” if the definition:
(i)    is approved as to form by the Commissioner; and
(ii)    is limited to:
1.    coverage provided by organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada; and
2.    any other coverage the Commissioner may approve for inclusion.
(3)    Unless defined otherwise, “other valid coverage” does not include:
(i)    group insurance; or
(ii)    coverage provided by union welfare plans or by employer or employee benefit organizations.
(4)    “Other valid coverage” may not include third party liability coverage.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-224 - Relation of Earnings to Insurance

(a)    A policy of health insurance may contain the following provision:
“Relation of earnings to insurance: If the total monthly amount of loss-of-time benefits promised for the same loss under all valid loss-of-time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of $200 or the sum of the monthly benefits specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time.”
(b)    The policy provision set forth in subsection (a) of this section may be inserted only in a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:
(1)    until the insured is at least 50 years old; or
(2)    if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.
(c)    (1)    The insurer may include in the provision set forth in subsection (a) of this section a definition of “valid loss-of-time coverage” if the definition:
(i)    is approved as to form by the Commissioner;
(ii)    is limited to:
1.    coverage provided by governmental units or organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada;
2.    any other coverage that the Commissioner may approve for inclusion; or
3.    a combination of these coverages.
(2)    Unless defined otherwise, “valid loss-of-time coverage” does not include:
(i)    coverage provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute; or
(ii)    coverage provided by union welfare plans or by employer or employee benefit organizations.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-226 - Conformity With Statutes of Residence

A policy of health insurance may contain the following provision:
“Conformity with state statutes: Any provision of this policy which, on its effective date is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-301 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Blanket health insurance” means the form of health insurance described in § 15-305 of this subtitle.
(c)    “Group health insurance” means the form of health insurance described in § 15-302 of this subtitle.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-304 - Group Health Insurance -- Direct Payment of Hospital or Medical Services

(a)    Except as provided in §§ 14–205.2 and 14–205.3 of this article, and subject to subsection (b) of this section, on request of the policyholder, a policy of group health insurance may contain a provision that all or part of the benefits provided by the policy for hospital, nursing, medical, or surgical services, at the insurer’s option, may be paid directly to the hospital or person that provides the services.
(b)    A policy of group health insurance may not require that hospital, nursing, medical, or surgical services be provided by a particular hospital or person.
(c)    A direct payment made under subsection (a) of this section discharges the insurer’s obligation with respect to the amount paid.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-305 - Blanket Health Insurance -- in General

(a)    (1)    Blanket health insurance is health insurance issued to or in the name of persons specified in this section to cover the groups of individuals described in this section.
(2)    The person to which or in the name of which a policy or contract is issued is deemed the policyholder.
(b)    A policy or contract of blanket health insurance may be issued to a common carrier or an operator, owner, or lessee of a means of transportation, to cover all individuals or all individuals of a class who may become passengers on the common carrier or means of transportation.
(c)    A policy or contract of blanket health insurance may be issued to an employer, to cover all employees, dependents, or guests who are defined by reference to specific hazards that are incident to the activities or operations of the employer or a class of employees, dependents, or guests similarly defined.
(d)    A policy or contract of blanket health insurance may be issued to a school or other institution of learning, a camp or its sponsor, or the head or principal of a school, other institution of learning, or camp, to cover students, campers, supervisors, or employees.
(e)    A policy or contract of blanket health insurance may be issued in the name of a religious, charitable, recreational, educational, or civic organization, to cover participants in activities sponsored by the organization.
(f)    A policy or contract of blanket health insurance may be issued to a sports team or its sponsors, to cover members, officials, and supervisors.
(g)    A policy or contract of blanket health insurance may be issued in the name of a volunteer fire department, first aid group, other similar volunteer group, or agency with jurisdiction over a volunteer fire department, first aid group, or other similar volunteer group, to cover all members of the volunteer fire department or similar volunteer group.
(h)    A policy or contract of blanket health insurance may be issued to cover any other risk, class of risks, or both that, in the discretion of the Commissioner, may be eligible for blanket health insurance.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-306 - Blanket Health Insurance -- Authority to Issue; Filing Policy Form Required

(a)    An insurer that is authorized to issue policies of health insurance in the State may issue blanket health insurance.
(b)    A policy of blanket health insurance may not be issued or delivered in the State unless a copy of the form for the policy is filed with the Commissioner in accordance with § 12-203 of this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-308 - Blanket Health Insurance -- Individual Applications and Certificates

(a)    An individual who is covered under a policy or contract of blanket health insurance may not be required to complete an individual application.
(b)    An insurer need not provide a certificate to each individual covered under a policy of blanket health insurance.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-309 - Blanket Health Insurance -- Payment of Benefits

(a)    Except as provided in subsections (b) through (d) of this section, benefits under a policy of blanket health insurance are payable to the insured, beneficiaries designated by the insured, or estate of the insured.
(b)    If the insured is under the age of 18 years or is mentally incompetent, benefits under a policy of blanket health insurance may be made payable to the insured’s parents, guardian, or other person who supports the insured.
(c)    If the employer has paid the entire cost of a policy of blanket health insurance, benefits under the policy may be made payable to the employer.
(d)    (1)    Subject to paragraph (2) of this subsection, a policy of blanket health insurance may contain a provision that all or part of the benefits provided by the policy for hospital, nursing, medical, or surgical services, at the insurer’s option, may be paid directly to the hospital or person that provides the services.
(2)    A policy of blanket health insurance may not require that hospital, nursing, medical, or surgical services be provided by a particular hospital or person.
(3)    A direct payment made under paragraph (1) of this subsection discharges the insurer’s obligation with respect to the amount paid.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions › Section 15-310 - Solicitation of Coverage Under Policy Issued in Other Jurisdiction

A person may not solicit coverage in the State under a policy of group health insurance or blanket health insurance issued in another jurisdiction without the prior written approval of the Commissioner, unless the type of group to be covered conforms substantially to one of the groups described in § 15-302 or § 15-305 of this subtitle.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-402 - Coverage for Unmarried Dependent Incapacitated Children, Grandchildren, and Individuals Under Guardianship

(a)    This section applies to:
(1)    each individual or group health insurance policy that is issued in the State; and
(2)    each contract that is issued in the State by a nonprofit health service plan or a health maintenance organization.
(b)    (1)    Notwithstanding any limiting age stated in a policy or contract subject to this section, a child, grandchild, or individual for whom guardianship is granted by court or testamentary appointment shall continue to be covered under the policy or contract as a dependent of an employee, member, or other covered individual if the child, grandchild, or individual under guardianship:
(i)    is unmarried;
(ii)    is chiefly dependent for support on the employee, member, or other covered individual; and
(iii)    at the time of reaching the limiting age, is incapable of self–support because of mental or physical incapacity that started before the child, grandchild, or individual under guardianship attained the limiting age.
(2)    A child, grandchild, or individual under guardianship who is covered under this section shall continue to be covered while remaining unmarried, dependent, and mentally or physically incapacitated until the coverage on the employee, member, or other covered individual on whom the child, grandchild, or individual under guardianship is dependent terminates.
(c)    To be eligible for coverage under this section:
(1)    a grandchild must be a dependent, and in the court–ordered custody, of the employee, member, or other covered individual; and
(2)    an individual must be a dependent and in the custody of the employee, member, or other covered individual as a result of a guardianship, other than a temporary guardianship of less than 12 months duration, granted by court or testamentary appointment.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-403 - Coverage for Grandchildren

(a)    This section applies to:
(1)    each individual health insurance policy that:
(i)    provides coverage on an expense–incurred basis; and
(ii)    provides coverage for a family member of the insured;
(2)    each group health insurance policy that:
(i)    provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and
(ii)    provides coverage for a family member of a covered employee or member;
(3)    each individual service or indemnity contract that:
(i)    is issued by a nonprofit health service plan; and
(ii)    provides coverage for a family member of the subscriber;
(4)    each individual contract that:
(i)    is issued by a health maintenance organization; and
(ii)    provides coverage for a family member of the subscriber; and
(5)    each group contract that:
(i)    is issued by a health maintenance organization;
(ii)    provides coverage for employees of an employer or employers or members of a union or unions; and
(iii)    provides coverage for a family member of the covered employee or member.
(b)    Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available, on request of the insured, subscriber, employee, or member, to a grandchild who:
(1)    is unmarried;
(2)    is in the court–ordered custody of the insured, subscriber, employee, or member;
(3)    resides with the insured, subscriber, employee, or member;
(4)    is the dependent of the insured, subscriber, employee, or member; and
(5)    has not attained the limiting age under the terms of the policy or contract.
(c)    On request, an insurer that issues an individual or group health insurance policy that provides coverage on an expense–incurred basis, a nonprofit health service plan, or a health maintenance organization shall offer family members’ coverage to an insured or subscriber regardless of the marital status of the insured or subscriber.
(d)    (1)    An insurer, nonprofit health service plan, or health maintenance organization may require proof that the insured or subscriber is the grandparent of the grandchild.
(2)    If the insurer, nonprofit health service plan, or health maintenance organization requires proof under this subsection, the insurer, nonprofit health service plan, or health maintenance organization shall pay the cost of the proof.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-403.1 - Coverage for Individuals Under Guardianship

(a)    This section applies to:
(1)    each individual health insurance policy that:
(i)    provides coverage on an expense–incurred basis; and
(ii)    provides coverage for a family member of the insured;
(2)    each group health insurance policy that:
(i)    provides coverage on an expense–incurred basis for employees of an employer or employers or members of a union or unions; and
(ii)    provides coverage for a family member of a covered employee or member;
(3)    each individual service or indemnity contract that:
(i)    is issued by a nonprofit health service plan; and
(ii)    provides coverage for a family member of the subscriber;
(4)    each individual contract that:
(i)    is issued by a health maintenance organization; and
(ii)    provides coverage for a family member of the subscriber; and
(5)    each group contract that:
(i)    is issued by a health maintenance organization;
(ii)    provides coverage for employees of an employer or employers or members of a union or unions; and
(iii)    provides coverage for a family member of the covered employee or member.
(b)    Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available, on request of the insured, subscriber, employee, or member, to an individual who:
(1)    is unmarried;
(2)    is under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months duration, of the insured, subscriber, employee, or member;
(3)    resides with the insured, subscriber, employee, or member;
(4)    is the dependent of the insured, subscriber, employee, or member; and
(5)    has not attained the limiting age under the terms of the policy or contract.
(c)    On request, an insurer that issues an individual or group health insurance policy that provides coverage on an expense–incurred basis, a nonprofit health service plan, or a health maintenance organization shall offer family members’ coverage to an insured or subscriber regardless of the marital status of the insured or subscriber.
(d)    (1)    An insurer, nonprofit health service plan, or health maintenance organization may require proof that the insured or subscriber is a guardian under court or testamentary appointment.
(2)    If the insurer, nonprofit health service plan, or health maintenance organization requires proof under this subsection, the insurer, nonprofit health service plan, or health maintenance organization shall pay the cost of the proof.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-403.2 - Coverage for Child Dependent of Domestic Partner

(a)    In this section, “child dependent of the domestic partner” means an  individual who:
(1)    is:
(i)    the natural child, stepchild, adopted  child, or grandchild of the domestic partner of an insured;
(ii)    a child placed with the domestic partner  of an insured for legal adoption; or
(iii)    a child who is under testamentary or  court appointed guardianship, other than temporary guardianship  of less than 12 months’ duration, of the domestic partner of an  insured;
(2)    is a dependent, as that term is used in 26 U.S.C.  §§ 104, 105, and 106, and any regulations adopted under those  sections, of the domestic partner of an insured;
(3)    resides with the insured;
(4)    is unmarried; and
(5)    is under the age of 25 years.
(b)    This section applies to each individual or group policy or  contract that:
(1)    allows family coverage; and
(2)    is issued by:
(i)    an insurer or nonprofit health service plan  that provides inpatient 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; or
(ii)    a health maintenance organization that  provides inpatient hospital, medical, or surgical benefits to  individuals or groups under contracts that are issued or delivered  in the State.
(c)    Each policy or contract subject to this section shall provide that the same health insurance benefits and eligibility guidelines that apply to any covered dependent are available to a domestic partner of an insured or a child dependent of the domestic partner of an insured at the request of:
(1)    an insured under an individual policy or contract  that is subject to this section; or
(2)    the group policyholder of a group policy or contract that is subject to this section.
(d)    An insurer, nonprofit health service plan, or health maintenance organization may require a group policyholder that requests coverage for a domestic partner or child dependent of the domestic partner of an insured under subsection (c)(2) of this section to provide proof of the eligibility of the domestic partner or child dependent of the domestic partner for coverage under this section.
(e)    The Commissioner shall adopt regulations to implement this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-404 - Addition of Children After Death of Spouse

(a)    This section applies to:
(1)    each group or blanket health insurance policy that is issued or delivered in the State and provides coverage on an expense-incurred basis; and
(2)    each group medical or major medical contract or certificate that is issued or delivered in the State by a nonprofit health service plan.
(b)    Each policy, contract, or certificate subject to this section shall provide a benefit that allows the addition of a certificate holder’s or subscriber’s dependent children to the certificate holder’s or subscriber’s policy or contract at any time and without evidence of insurability if:
(1)    the dependent children previously were covered under the policy or contract of the certificate holder’s or subscriber’s spouse; and
(2)    the certificate holder’s or subscriber’s spouse has died.
(c)    This section applies regardless of whether a certificate holder’s or subscriber’s dependent children are eligible for any continuation or conversion privileges under the policy or contract of the certificate holder’s or subscriber’s spouse.
(d)    Within 6 months after the death of the spouse, the certificate holder or subscriber must exercise the benefit provided under this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-406 - Medical Assistance

(a)    In this section, “health insurance coverage” means health care coverage under which medical care services can be provided to a child.
(b)    This section applies to:
(1)    commercial insurers, nonprofit health service plans, and health maintenance organizations that operate in the State under a certificate of authority;
(2)    group health plans, as defined in § 607(1) of the Employee Retirement Income Security Act of 1974 (ERISA); and
(3)    persons that offer a service benefit plan, as defined in federal law.
(c)    An entity subject to this section may not consider whether an individual is eligible for or receives medical assistance from this State or another state under 42 U.S.C. § 1396a when:
(1)    determining the eligibility of the individual for enrollment in health insurance coverage; or
(2)    calculating any payments for benefits for which the individual is eligible under the health insurance coverage.
(d)    On presentation of a claim, an entity subject to this section shall reimburse the State to the extent that:
(1)    the State has paid for expenses for health care services that are provided to an eligible individual and covered under the Maryland Medical Assistance Program; and
(2)    those health care services are included under the individual’s health insurance coverage provided by the entity.
(e)    If a State agency has been assigned the rights of an individual who is eligible for medical assistance and who has health insurance coverage provided by an entity subject to this section, the entity may not impose on the State agency requirements that are different from the requirements that apply to an insurance producer, assignee, or any other individual who has health insurance coverage provided by the entity.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-409.1 - Continuation Coverage for Involuntarily Terminated Employees -- Small Employers

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Act” means the federal American Recovery and Reinvestment Act of 2009 (P.L. 111–5).
(3)    “Carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan; or
(iii)    a health maintenance organization.
(4)    “Small employer” has the meaning stated in § 15–1201 of this title.
(b)    This section applies to a carrier that issues health benefit plans to small employers in accordance with Subtitle 12 of this title.
(c)    A carrier shall allow an extended election period for continuation coverage under § 15–409 of this subtitle if the individual:
(1)    was involuntarily terminated from employment by a small employer between September 1, 2008, and February 16, 2009, inclusive, as described in § 3001(a)(3)(C) of the Act;
(2)    is an assistance eligible individual, as defined in § 3001(a)(3) of the Act, or would be an assistance eligible individual if an election of continuation coverage under § 15–409 of this subtitle was in effect on the date of enactment of the Act; and
(3)    was eligible for continuation coverage under § 15–409 of this subtitle at the time of the individual’s termination of employment.
(d)    The extended election period provided under this section shall continue until 60 days after provision of the notification required by § 3001(a)(7)(C) of the Act if the notification describes the extended election period required under this section.
(e)    Any continuation coverage elected by an individual during an extended election period under this section:
(1)    shall begin during the first period of coverage beginning on or after the individual’s election of continuation coverage; and
(2)    may not extend beyond the period of continuation coverage that would have been required under § 15–409 of this subtitle if the coverage had been elected as required under that section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-411 - Open Enrollment of Involuntarily Terminated Spouse Losing Coverage

(a)    Each group health insurance contract or policy that is issued by an insurer or nonprofit health service plan shall provide continuous open enrollment for the purpose of allowing a married employee who is enrolled under the contract or policy to alter the terms of the employee’s coverage to include the employee’s spouse or children if the employee’s spouse loses coverage under another group health insurance contract or policy because of the involuntary termination of the spouse’s employment other than for cause.
(b)    A group health insurance contract or policy may not require evidence of insurability for a spouse who qualifies for group health insurance coverage under this section.
(c)    A married employee who wishes to alter the terms of the employee’s coverage under this section shall notify the employer within 6 months after the date on which the coverage of the employee’s spouse under another group health insurance contract or policy terminates.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-416 - Notice to Parents of Impending Loss of Child's Coverage

(a)    This section applies to insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery in the State individual, group, or blanket health insurance policies and contracts.
(b)    At least 60 days before a child who is covered under a parent’s individual, group, or blanket health insurance policy or contract reaches the limiting age under the policy or contract, an entity subject to this section shall:
(1)    notify the parent of criteria under which a child may remain eligible for coverage as a dependent under the policy or contract; and
(2)    provide information regarding:
(i)    any other policies that may be available to the child from the entity; and
(ii)    the availability of additional information from the Administration regarding individual policies in the State.
(c)    The Commissioner shall establish and publish by bulletin the notice to be given under this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-417 - Coverage for Part-Time Students With Disabilities

(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 that provides health benefits to full-time students over the age of 18 may not exclude health benefits for a student over the age of 18 who:
(1)    is enrolled less than full time as a result of a documented disability that prevents the student from maintaining a full-time course load; and
(2)    is maintaining a course load of at least 7 credit hours per semester.
(c)    An entity subject to this section may require the insured, subscriber, or enrollee to provide verification of the disability from a disability services professional employed by the institution of higher education that the student attends or a health care provider with special expertise in and knowledge of the disability.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies › Section 15-418 - Child Dependent Coverage

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan; or
(iii)    a health maintenance organization.
(3)    “Child dependent” means an individual who:
(i)    is:
1.    the grandchild of the insured; or
2.    a child who is entitled to dependent coverage under § 15–403.1 of this subtitle;
(ii)    is unmarried; and
(iii)    is under the age of 25 years.
(b)    (1)    This section applies to:
(i)    each policy of individual or group health insurance that is issued in the State;
(ii)    each contract that is issued in the State by a nonprofit health service plan; and
(iii)    each contract that is issued in the State by a health maintenance organization.
(2)    Notwithstanding paragraph (1) of this subsection, this section does not apply to:
(i)    a contract covering one or more, or any combination of the following:
1.    coverage only for loss caused by an accident;
2.    disability coverage;
3.    credit–only insurance; or
4.    long–term care coverage; or
(ii)    the following benefits if they are provided under a separate contract:
1.    dental coverage;
2.    vision coverage;
3.    Medicare supplement insurance;
4.    coverage limited to benefits for a specified disease or diseases;
5.    travel accident or sickness coverage; and
6.    fixed indemnity limited benefit insurance that does not provide benefits on an expense incurred basis.
(c)    Each policy or contract subject to this section that provides coverage for dependents shall:
(1)    include coverage for a child dependent;
(2)    provide the same health insurance benefits to a child dependent that are available to any other covered dependent; and
(3)    provide health insurance benefits to a child dependent at the same rate or premium applicable to any other covered dependent.
(d)    This section does not limit or alter any right to dependent coverage or to the continuation of coverage that is otherwise provided for in this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-502 - Eligibility for State Medical Assistance

(a)    This section applies to each individual or group policy or certificate of health insurance or automobile insurance that is:
(1)    delivered or issued for delivery in the State by an insurer or nonprofit health service plan; and
(2)    issued, renewed, amended, or reissued on or after July 1, 1978.
(b)    A policy or certificate subject to this section that provides or pays for health care benefits may not contain a provision that denies or reduces benefits because services are rendered to a policyholder, certificate holder, or beneficiary who is eligible for or receives medical assistance under § 15-103 of the Health - General Article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-503 - Exposure to Diethylstilbestrol

An insurer or nonprofit health service plan may not deny, cancel, or refuse to renew an individual, group, or blanket health insurance policy solely because the insured has been exposed to diethylstilbestrol, commonly known as DES.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-505 - Exclusion of Payments for Leaving Home Confinement

(a)    This section applies to each individual, group, or blanket health insurance policy or certificate that is issued by an insurer or nonprofit health service plan on or after July 2, 1970, covering a person in the State.
(b)    (1)    A policy or certificate subject to this section that provides coverage for disability or sickness while an individual is confined at home may not exclude payments or benefits because the individual leaves home for medical treatment.
(2)    Coverage extends to individuals confined at home, who are otherwise eligible, regardless of the place of medical treatment.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-506 - Effect of Marital Status on Maternity Benefits

(a)    Each insurer and nonprofit health service plan that provides maternity benefits in a policy form customarily issued on an individual or family basis shall offer the benefits to individuals regardless of marital status.
(b)    (1)    This subsection applies to each group or blanket health insurance policy that is delivered or issued for delivery in the State by an insurer or nonprofit health service plan.
(2)    Each policy subject to this subsection that provides maternity benefits for pregnancy and childbirth of employees or members or of covered dependents of employees or members, whether the benefits are in the form of disability, hospital, medical, or surgical benefits, shall provide identical benefits regardless of marital status to:
(i)    all covered employees or members; or
(ii)    all covered employees or members and all covered dependents of employees or members.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-508.1 - Exclusionary Provisions

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means an insurer or a nonprofit health service plan.
(3)    “Exclusionary rider” means an endorsement to an individual health benefit plan that excludes benefits for one or more named conditions that are discovered by a carrier during the underwriting process.
(4)    “Health benefit plan” has the meaning stated in § 15–1301 of this title.
(5)    “Individual health benefit plan” means a health benefit plan issued by a carrier that insures:
(i)    only one individual; or
(ii)    one individual and one or more family members of the individual.
(b)    This section applies to individual health benefit plans that are issued or delivered in the State before March 23, 2010.
(c)    A carrier may not attach an exclusionary rider to an individual health benefit plan unless the carrier obtains the prior written consent of the policyholder.
(d)    A carrier may impose a preexisting condition exclusion or limitation on an individual for a condition that was not discovered during the underwriting process for an individual health benefit plan only if the exclusion or limitation:
(1)    relates to a condition of the individual, regardless of its cause, for which medical advice, diagnosis, care, or treatment was recommended or received within the 12–month period immediately preceding the effective date of the individual’s coverage; and
(2)    extends for a period of not more than 12 months after the effective date of the individual’s coverage.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage › Section 15-510 - Behavioral Health Care Services Provided at Public School or School-Based Health Center

No individual, group, or blanket insurance policy or contract issued or delivered in the State by an insurer, a nonprofit health service plan, or a health maintenance organization may deny a covered medically necessary behavioral health care service provided by a participating provider to a member who is a student solely on the basis that the service is provided at a public school or through a school–based health center under § 7–440 of the Education Article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 6 - Required Reimbursement of Institutions › Section 15-601 - Benefits for Using Low-Cost Hospitals

(a)    This section applies to insurers and nonprofit health service plans that provide hospital benefits in the State under individual, group, or blanket health insurance policies.
(b)    Each entity subject to this section that offers benefits to an insured or beneficiary who uses designated low-cost hospitals, that are different from the benefits offered when other hospitals are used, shall base its designation of a low-cost hospital on information that:
(1)    excludes the reasonable cost of medical education and of uncompensated care as determined by the Health Services Cost Review Commission;
(2)    excludes the cost associated with a shock trauma facility as determined by the Health Services Cost Review Commission;
(3)    excludes the amount in rates approved by the Health Services Cost Review Commission for undergraduate nursing education;
(4)    excludes from consideration each hospital that is determined by the Maryland Health Care Commission to be a sole community provider; and
(5)    compares hospitals on a regional basis, unless the entity demonstrates to the satisfaction of the Commissioner that a statewide comparison is more appropriate.
(c)    An entity subject to this section that provides hospital benefits under subsection (b) of this section may not subsidize those benefits from premiums earned by other benefit plans, programs, or policies.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 6 - Required Reimbursement of Institutions › Section 15-602 - Treatment in State or Local Government Hospitals or Institutions

(a)    This section applies to each individual, group, or blanket health insurance policy or certificate that is delivered or issued for delivery in the State by an insurer or nonprofit health service plan on or after July 2, 1969.
(b)    A policy or certificate subject to this section may not exclude payments or benefits for the treatment of tuberculosis, mental illness, or another illness covered under the policy or certificate because treatment is received in a hospital or other institution of the State or of a county or municipal corporation of the State, whether or not the hospital or other institution is deemed charitable.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 6 - Required Reimbursement of Institutions › Section 15-603 - Reimbursement of Maryland Department of Health

(a)    If the Maryland Department of Health notifies an insurer or nonprofit health service plan that the Department has paid for or provided services to an individual who is covered under an individual, group, or blanket health insurance policy or contract that the insurer or nonprofit health service plan issued, delivered, or renewed in the State, the insurer or nonprofit health service plan shall reimburse the Department for the cost of the services, regardless of any provision in the health insurance policy or contract that requires payment to the policyholder, subscriber, or another payee.
(b)    (1)    The benefits payable to the Maryland Department of Health under this section are limited to those benefits available under the terms and conditions of the health insurance policy or contract for the services paid for or provided by the Department.
(2)    An insurer or nonprofit health service plan is not required to make payment to the Department under this section if, before receiving notice from the Department under subsection (a) of this section, the insurer or nonprofit health service plan has paid the benefits available under the health insurance policy or contract in good faith and in accordance with the terms and conditions of the policy or contract.
(c)    Notwithstanding any other provision of a health insurance policy, contract, or certificate, an insurer or nonprofit health service plan may not refuse to reimburse the Maryland Department of Health because of the manner, form, or date of a claim for reimbursement if, within 2 years after the date of the service for which reimbursement is sought, the Department provides to the insurer or nonprofit health service plan sufficient information to determine the liability of the insurer or nonprofit health service plan.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 6 - Required Reimbursement of Institutions › Section 15-604 - Rates for Payments to Hospitals; Compliance With All-Payor Model Contract

Each authorized insurer, nonprofit health service plan, and fraternal benefit society, and each managed care organization that is authorized to receive Medicaid prepaid capitation payments under Title 15, Subtitle 1 of the Health – General Article, shall:
(1)    pay hospitals for hospital services rendered on the basis of the rate approved by the Health Services Cost Review Commission; and
(2)    comply with the applicable terms and conditions of the all–payer model contract, as defined in § 19–201 of the Health – General Article.