reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-405 - Application for Certificate of Authority

(a)    An applicant for a certificate of authority shall:
(1)    file with the Commissioner an application, verified by an officer or authorized representative of the dental plan organization, on the form that the Commissioner provides; and
(2)    pay to the Commissioner an application fee of $200.
(b)    An application for a certificate of authority shall include:
(1)    the basic organizational documents of the dental plan organization, including the articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, and shareholder agreement;
(2)    all amendments to the organizational documents of the dental plan organization;
(3)    the bylaws, rules and regulations, or similar documents that regulate the conduct or internal affairs of the dental plan organization;
(4)    the names, addresses, and official positions of the individuals who are responsible for conducting the affairs of the dental plan organization, including:
(i)    the members of the board of directors, board of trustees, executive committee, or other governing board or committee;
(ii)    for a corporation, the principal officers; and
(iii)    for a partnership or association, the partners or members;
(5)    each contract made between a dentist and the dental plan organization;
(6)    each contract made between a dentist and an individual listed in item (4) of this subsection, a consultant, or a business manager;
(7)    a description of the dental plan organization and its dental plan or plans, facilities, and personnel;
(8)    the form of evidence of coverage to be issued to enrollees;
(9)    the form of each group contract that is issued to employers, unions, trustees, or others;
(10)    a financial statement that details the assets, liabilities, and sources of financial support for the dental plan organization or, if the financial affairs are audited by an independent certified public accountant, a copy of the most recent regular certified financial statement, unless the Commissioner determines that additional or more recent financial information is required for the proper administration of this subtitle;
(11)    the proposed method of marketing the dental plan, a financial plan with a 3-year projection of the initial operating results, and a statement of the sources of working capital and any other sources of funding;
(12)    if a dental plan organization is not domiciled in the State, an executed power of attorney that appoints the Commissioner as attorney for service of process issued against the dental plan organization in the State;
(13)    a description of the geographic area to be served by the dental plan organization; and
(14)    any other information that the Commissioner requires.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-407 - Issuance or Disapproval of Certificate of Authority

(a)    If the Commissioner is satisfied that the individuals who are responsible for conducting the affairs of the dental plan organization are trustworthy and capable of providing, arranging for, or administering the services offered by the dental plan, the Commissioner shall issue a certificate of authority.
(b)    If the Commissioner disapproves an application for a certificate of authority, the Commissioner shall notify the dental plan organization in writing of the reasons for disapproval.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-408 - Term and Renewal of Certificate of Authority

(a)    A certificate of authority expires on the first June 30 after its effective date unless it is renewed as provided in this section.
(b)    The Commissioner shall renew the certificate of authority of a dental plan organization if the dental plan organization remains in compliance with this subtitle and pays to the Commissioner a renewal fee of $100.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-409 - Suspensions and Revocations

(a)    The Commissioner may suspend or revoke a certificate of authority issued to a dental plan organization under this subtitle if the Commissioner finds that:
(1)    the dental plan organization is operating in a manner significantly contrary to that described in §§ 14-403, 14-405, 14-407, and 14-408 of this subtitle;
(2)    the dental plan organization issues evidence of coverage that does not comply with § 14-410 of this subtitle;
(3)    the dental plan organization can no longer be expected to meet its obligations to enrollees;
(4)    the agreements of the dental plan organization with dentists are not sufficient to provide the dental services covered by the dental plan;
(5)    the dental plan organization, or authorized person acting on its behalf, has advertised or merchandised its services in an untrue or misleading manner;
(6)    the conditions or methods of operation of the dental plan organization make continued operation hazardous to enrollees or the public; or
(7)    the dental plan organization has failed to comply with this subtitle or any regulations adopted under this subtitle.
(b)    If the Commissioner has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, the Commissioner shall notify the dental plan organization of the suspension or revocation in writing and the grounds.
(c)    If the Commissioner suspends the certificate of authority, the dental plan organization may not accept additional enrollees or engage in advertising or solicitation during the period of suspension.
(d)    (1)    If the Commissioner revokes the certificate of authority, the dental plan organization shall dissolve its structure immediately after the effective date of the order of revocation and may not conduct further business, except as essential to the orderly conclusion of the affairs of the dental plan organization.
(2)    By written order, the Commissioner may allow further operation of the dental plan organization if the Commissioner finds that it is in the best interest of enrollees and that enrollees will be afforded the greatest practical opportunity to obtain continuing dental plan coverage.
(e)    Instead of or in addition to suspending or revoking a certificate of authority, the Commissioner may:
(1)    impose on the holder a penalty of not less than $1,000 but not exceeding $50,000 for each violation of this subtitle; and
(2)    require the holder to make restitution to any person who has suffered financial injury because of a violation of this subtitle.
(f)    (1)    Notwithstanding subsections (c), (d), and (e) of this section, a dental plan organization that has had its certificate of authority suspended or revoked, has been ordered to pay a penalty or make restitution, or has suffered an adverse decision by the Commissioner is entitled to a hearing under § 2-210 of this article.
(2)    Hearings and appeals from orders of the Commissioner are governed by §§ 2-203 and 2-210 through 2-215 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-410 - Evidence of Coverage

(a)    Each enrollee shall receive evidence of coverage that indicates specifically the nature and extent of coverage and the total amount or percentage of payment, if any, that the enrollee must pay for dental services.
(b)    (1)    Except as provided under paragraph (2) of this subsection, a dental plan organization shall issue evidence of coverage to each enrollee of the dental plan organization.
(2)    If an individual enrollee obtains coverage through a policy or through a contract issued by a medical or dental service corporation, the insurer that issued the policy or the medical or dental service corporation shall issue evidence of coverage.
(c)    The dental plan organization, insurer, or medical or dental service corporation may not issue or deliver evidence of coverage or an amendment to evidence of coverage until a copy of the form of evidence of coverage or amendment is filed with and approved by the Commissioner.
(d)    The evidence of coverage shall contain:
(1)    a clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:
(i)    the dental services and the insurance or other benefits, if any, to which enrollees are entitled;
(ii)    any limitations on the services or kind of benefits to be provided, including any charge, deductible, or copayment feature; and
(iii)    where and in what manner information is available about how services may be obtained; and
(2)    a clear and understandable description of the dental plan organization’s method for resolving enrollee complaints.
(e)    A dental plan organization, insurer, or medical or dental service corporation that makes a change in evidence of coverage or the amount or percentage of payment that the enrollee must pay, shall issue to the enrollee evidence of the change in a separate document.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-411 - Investigations and Examinations

(a)    The Commissioner may investigate the business and examine the books, accounts, records, and files of each dental plan organization and to do so shall have reasonably free access to those materials and to the offices and places of business of the dental plan organization.
(b)    (1)    A dental plan organization shall preserve its books, accounts, and records for at least 5 years.
(2)    Preservation by photographic reproduction shall constitute compliance with this subtitle.
(c)    At the discretion of the Commissioner, the Secretary of Health and the State Board of Dental Examiners may participate in investigations and examinations described in this section to verify the solvency of a dental plan organization.
(d)    In an examination under this section, the person examined shall pay the expense incurred by the Commissioner, Secretary of Health, and State Board of Dental Examiners in accordance with § 2–208 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-412 - Complaint System

(a)    (1)    A dental plan organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees about services of the dental plan organization.
(2)    The dental plan organization shall maintain records of all written complaints initiated by enrollees.
(b)    (1)    The Commissioner may examine the complaint system of a dental plan organization.
(2)    If the Commissioner determines that the complaint system is inadequate, the Commissioner may require a revision of the complaint system.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-413 - Annual Report

(a)    On or before March 1 of each year, each dental plan organization shall file with the Commissioner a complete statement of its financial condition, transactions, and affairs for the immediately preceding calendar year.
(b)    The annual statement shall:
(1)    be in the form and have the content approved for current use by the National Association of Insurance Commissioners or its successor organization; and
(2)    contain any additional information that the Commissioner requires.
(c)    Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an annual statement on or before March 10 shall pay a penalty of:
(1)    $100 for each day from March 1 to March 10, both inclusive; and
(2)    $150 for each day from March 11 to the day before the Commissioner receives the report, both inclusive.
(d)    At any time, the Commissioner may require a dental plan organization doing business in the State to file an interim statement containing the information that the Commissioner considers necessary.
(e)    (1)    Except as provided in paragraph (5) of this subsection, on or before June 1 of each year, each dental plan organization shall file with the Commissioner an audited financial report for the immediately preceding calendar year.
(2)    The dental plan organization shall have the audited financial report prepared by an independent certified public accountant.
(3)    The Commissioner may:
(i)    set requirements for the form and content of the audited financial report; and
(ii)    for good cause, extend the time for filing the audited financial report.
(4)    Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an audited financial report on or before June 10 shall pay a penalty of:
(i)    $100 for each day from June 1 to June 10, both inclusive; and
(ii)    $150 for each day from June 11 to the day before the Commissioner receives the report, both inclusive.
(5)    With 90 days’ advance notice, the Commissioner may require a dental plan organization to file an audited financial report earlier than the date specified in paragraph (1) of this subsection.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-415 - Misrepresentation

(a)    A dental plan organization or its representative may not cause or knowingly allow:
(1)    advertising that is untrue or misleading;
(2)    solicitation that is untrue or misleading; or
(3)    any form of evidence of coverage that is deceptive.
(b)    Unless a dental plan organization holds a certificate of authority as an insurer, the dental plan organization may not use in its name, evidence of coverage, or literature:
(1)    the words “insurance”, “assurance”, “casualty”, “surety”, or “mutual”; or
(2)    any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of an insurer authorized to do business in the State.
(c)    The Commissioner shall enforce this section.
(d)    This subtitle does not limit the powers of the Attorney General and the procedures with respect to consumer fraud.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-416 - Cease and Desist Orders

(a)    The Commissioner may issue an order that directs a dental plan organization or its representative to cease and desist from engaging in an act or practice that violates this subtitle.
(b)    (1)    Within 20 days after service of the cease and desist order, the dental plan organization or its representative may request a hearing to determine whether a violation of this subtitle has occurred.
(2)    A hearing under this subsection shall be conducted in accordance with § 2-213 of this article and is subject to judicial review in accordance with § 2-215 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-417 - Injunctions

(a)    The Commissioner may bring an action in a court of competent jurisdiction of the State to enjoin a dental plan organization from transacting any further business, or from transferring or disposing of its property, if:
(1)    the dental plan organization becomes insolvent or suspends its ordinary business for lack of funds; or
(2)    the Commissioner finds, as a result of an examination authorized by this subtitle or in any other manner, that:
(i)    the dental plan organization is exceeding its powers or is violating the law;
(ii)    the condition or methods of business of the dental plan organization may render the continuance of its operations hazardous to enrollees or the public; or
(iii)    the assets of the dental plan organization are less than its liabilities.
(b)    The court may:
(1)    proceed in the action in a summary manner or otherwise;
(2)    grant injunctive relief and appoint a receiver, with power to:
(i)    sue for, collect, receive, take into possession, sell, convey, and assign all the goods and chattels, rights and credits, money and effects, lands and tenement, books, papers, choses in action, bills, notes, and property of every description belonging to the dental plan organization;
(ii)    authorize the purchase of continuing coverage for enrollees utilizing the remaining assets; and
(iii)    hold and dispose of any proceeds under the direction of the court; and
(3)    cause the receiver to continue the existing operations of the dental plan organization, under court supervision, until the next anniversary of the subscription certificates and contracts then in force.
(c)    A dental plan organization is deemed insolvent whenever it is presently or prospectively unable to fulfill its outstanding contracts and maintain the surpluses required under this subtitle.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 4 - Dental Plan Organization Act › Section 14-418 - Public Documents; Confidential Records

(a)    Except for contracts referred to in § 14-405(b)(5) of this subtitle and complaints filed under § 14-412 of this subtitle, applications, filings, and reports required under this subtitle are public documents and may not be considered confidential.
(b)    (1)    Except as provided in paragraph (2) of this subsection, information obtained by a dental plan organization about the diagnosis, treatment, or health of an enrollee is confidential and may not be disclosed.
(2)    A dental plan organization may disclose information described in paragraph (1) of this subsection:
(i)    to the extent that disclosure may be necessary to carry out the purposes of this subtitle;
(ii)    with the express consent of the enrollee;
(iii)    under statute or court order for the production or discovery of evidence; or
(iv)    if the information is pertinent to a claim or in litigation between the enrollee and dental plan organization.
(c)    A dental plan organization may claim any statutory privileges against disclosure of information that the dentist who provides the information to the dental plan organization may claim.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-602 - General Consideration

(a)    Except as provided in subsection (b) of this section, this subtitle does not apply to an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization that holds a certificate of authority in this State.
(b)    An insurer, nonprofit health service plan, health maintenance organization, or dental plan organization shall:
(1)    comply with §§ 14–606 through 14–611 of this subtitle;
(2)    notify the Commissioner in writing that it sells, markets, or solicits a discount medical plan or discount drug plan in the State; and
(3)    (i)    file annually with the Commissioner a current list of the persons, other than licensed insurance producers, who  are authorized to sell, market, or solicit in the State a discount medical plan or discount drug plan established by the insurer, nonprofit health service plan, health maintenance organization, or dental plan organization; and
(ii)    provide the Commissioner with an additional list on request.
(c)    An insurer, nonprofit health service plan, health maintenance organization, or dental plan organization may file the list required under subsection (b)(3) of this section electronically, in a format prescribed by the Commissioner.
(d)    This subtitle does not apply to Medicare prescription drug plans or to a State prescription drug plan.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-603 - Registration Required

(a)    (1)    An entity shall register with the Commissioner as a discount medical plan organization before a discount medical plan established by that entity is sold, marketed, or solicited in the State.
(2)    A discount medical plan may not be sold, marketed, or solicited in the State unless the discount medical plan organization that established the discount medical plan is registered with the Commissioner.
(b)    (1)    An entity shall register with the Commissioner as a discount drug plan organization before a discount drug plan established by that entity is sold, marketed, or solicited in the State.
(2)    A discount drug plan may not be sold, marketed, or solicited in the State unless the discount drug plan organization that established the discount drug plan is registered with the Commissioner.
(c)    An applicant for registration shall:
(1)    file with the Commissioner an application on the form that the Commissioner requires; and
(2)    pay to the Commissioner  an application fee of $250.
(d)    An entity that is required to register with the Commissioner under both subsections (a) and (b) of this section may file one application with the Commissioner and pay one application fee.
(e)    An applicant shall file with its application a list of the persons authorized to sell, market, or solicit a discount medical plan or discount drug plan established by the applicant.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-604 - Registration -- Expiration and Renewal

(a)    A registration expires on the second June 30 following the registration unless it is renewed as provided in this section.
(b)    Before a registration expires, the registrant may renew it for an additional 2–year term, if the registrant:
(1)    otherwise is entitled to be registered;
(2)    files with the Commissioner a renewal application on the form that the Commissioner  requires; and
(3)    pays to the Commissioner a renewal fee of $150.
(c)    An application for renewal of a registration shall be considered made in a timely manner if it is postmarked on or before June 30 of the year of renewal.
(d)    Subject to the provisions of § 14–605 of this subtitle, the Commissioner shall renew the registration of each registrant that meets the requirements of this section.
(e)    (1)    A registrant shall file annually with the Commissioner a current list of the persons authorized to sell, market, or solicit in the State a discount medical plan or discount drug plan established by the registrant.
(2)    A registrant shall provide the Commissioner an additional list on request.
(3)    A registrant may file the list required under this subsection electronically, in a format prescribed by the Commissioner.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-605 - Registration -- Denial, Refusal to Renew, Suspension, Revocation

(a)    Subject to the hearing provisions of Title 2 of this article, the Commissioner  may deny a registration to an applicant or refuse to renew, suspend, or revoke the registration of a registrant if the applicant or registrant, or an officer, director, or employee of the applicant or registrant:
(1)    makes a material misstatement or misrepresentation in an application for registration;
(2)    fraudulently or deceptively obtains or attempts to obtain a registration for the applicant or registrant or for another;
(3)    has been convicted of a felony or of a misdemeanor involving moral turpitude;
(4)    in connection with the administration of a discount medical plan or discount drug plan, commits fraud or engages in illegal or dishonest activities;
(5)    has violated any provision of this subtitle or a regulation adopted under it;
(6)    provides a false, falsely disparaging, or misleading oral or written statement, visual description, or other representation of any kind that has the capacity, tendency, or effect of deceiving or misleading consumers;
(7)    makes a representation that a discount medical plan or discount drug plan has a sponsorship, approval, characteristic, use, or benefit that it does not have;
(8)    has violated § 13–301 of the Commercial Law Article; or
(9)    fails to maintain on file with the Commissioner a current list of the persons authorized to sell, market, or solicit a discount medical plan or discount drug plan established by the applicant or the registrant.
(b)    This section does not limit any regulatory power of the Commissioner under Title 2 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-606 - Prohibited Acts

A discount medical plan organization and a discount drug plan organization may not:
(1)    use in their advertisements, marketing material, brochures, and discount cards the term “insurance” except:
(i)    in the name of an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization whose corporate name includes the word “insurance”;
(ii)    when comparing the discount medical plan or discount drug plan to insurance or otherwise distinguishing the discount medical plan or discount drug plan from insurance; or
(iii)    as otherwise provided in this subtitle;
(2)    use in their advertisements, marketing material, brochures, and discount cards the terms “health plan”, “coverage”, “copay”, “copayments”, “preexisting conditions”, “guaranteed issue”, “premium”, “ppo”, “preferred provider organization”, or other terms in a context that could reasonably mislead a person into believing the discount medical plan or discount drug plan was health insurance;
(3)    have restrictions on access to discount medical plan or discount drug plan providers, including waiting periods and notification periods;
(4)    pay providers any fees for medical services, pharmaceutical supplies, prescription drugs, or medical equipment and supplies, except that a discount medical plan organization or a discount drug plan organization that also has an active registration under Title 8, Subtitle 3 of this article may continue to pay fees to providers in its capacity as a third party administrator;
(5)    refuse to modify the method of payment for membership in a discount medical plan or a discount drug plan on request, unless a specific method of payment is required as a term of the discount medical plan or the discount drug plan and was agreed to in writing in advance;
(6)    if membership is billed on a monthly basis, refuse to permit membership to terminate without financial penalty on no more than 30 calendar days’ written notice; or
(7)    (i)    continue electronic fund transfer as a method of payment more than 30 calendar days after a written request for termination of electronic fund transfer has been made; or
(ii)    require the member to notify more than one entity that is either the discount medical plan organization or the discount drug plan organization or an entity identified by the discount medical plan organization or the discount drug plan organization that electronic fund transfer should be terminated.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-608 - Refunds of Fees, Dues, or Charges on Cancellation of Registration

(a)    (1)    If membership in a discount medical plan or a discount drug plan is canceled within the first 30 calendar days after the effective date of enrollment, all fees, dues, charges, or other financial consideration, except a nominal fee, not to exceed any fees, dues, charges, or other financial consideration the  member has already paid, associated with enrollment costs that were part of the cost of the discount medical plan card or the discount drug plan card, shall be refunded to the payor on return of the discount medical plan card to the discount medical plan organization or return of the discount drug plan card to the discount drug plan organization.
(2)    The Commissioner, in consultation with the Attorney General, shall adopt regulations that establish standards for determining the nominal fee associated with enrollment costs that may be retained by a discount medical plan organization or a discount drug plan organization under this subsection.
(3)    Subject to paragraph (1) of this subsection, any regulation adopted under this subsection shall include a cap on the nominal fee that may be retained.
(b)    If a discount medical plan organization or a discount drug plan organization cancels a membership for any reason other than nonpayment, the discount medical plan organization or discount drug plan organization shall make a pro rata refund to the payor of all fees, dues, charges, or other financial consideration within 30 calendar days after the date of cancellation.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-609 - Cards

(a)    Each discount medical plan organization and each discount drug plan organization shall provide to a plan member or to a plan member for the member’s family a discount card that includes, at a minimum, the following data elements:
(1)    a statement that the discount medical plan or discount drug plan is not insurance;
(2)    (i)    the name or identifying trademark of the discount medical plan organization or the discount drug plan organization; or
(ii)    the name or identifying trademark of the provider networks that participate with the discount medical plan or discount drug plan; and
(3)    the telephone number that the plan member may call for assistance.
(b)    (1)    If a change occurs in the data element required under subsection (a)(3) of this section, a discount medical plan organization or a discount drug plan organization shall reissue a discount card.
(2)    A discount medical plan organization or a discount drug plan organization shall notify a plan member when there is a material change in plan benefits or in the data elements required under subsection (a)(1), (2), or (3) of this section.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-610 - Examinations

(a)    Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, records, and assets of a discount medical plan organization or discount drug plan organization.
(b)    The examination shall be conducted in accordance with § 2–207 of this article.
(c)    The expense of the examination shall be paid in accordance with § 2–208 of this article.
(d)    The reports of the examination and investigation shall be issued in accordance with § 2–209 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations › Section 14-611 - Enforcement by Orders of Commissioner

(a)    To enforce this subtitle and any regulation adopted under it, the Commissioner  may issue an order:
(1)    that requires the violator to cease and desist from the identified violation and further similar violations;
(2)    that requires the violator to take specific affirmative action to correct the violation;
(3)    that requires the violator to make restitution of money, property, or other assets to a person who has suffered financial injury because of the violation; or
(4)    that requires a discount medical plan organization or a discount drug plan organization to make restitution of money, property, or other assets to a person who has suffered financial injury because of a violation by any person authorized to sell, market, solicit, or administer a discount medical plan or discount drug plan established by the discount medical plan organization or discount drug plan organization while the person is acting with the actual or apparent authority of the discount medical plan organization or discount drug plan organization.
(b)    (1)    An order of the Commissioner  issued under this section may be served on a violator who is registered under this subtitle in the manner provided in Title 2 of this article.
(2)    An order of the Commissioner  issued under this section may be served on a violator that is not registered under this subtitle in the manner provided for service on an unauthorized insurer that does an act of insurance business in Title 4 of this article.
(3)    A request for a hearing on any order issued under this subsection does not stay that portion of the order that requires the violator to cease and desist from conduct identified in the order.
(4)    The Commissioner  may file a petition in the circuit court of any county to enforce an order issued under this section, whether or not a hearing has been requested or, if requested, whether or not a hearing has been held.
(5)    If the Commissioner prevails in an action brought by the Commissioner under this section, the Commissioner may recover for the use of the State reasonable attorney’s fees and the costs of the action.
(c)    (1)    In addition to any other enforcement action taken by the Commissioner under this section, the Commissioner may impose a civil penalty of not more than $10,000 for each violation of this subtitle.
(2)    Notwithstanding paragraph (1) of this subsection, the Commissioner  may impose a civil penalty of not more than $1,000 per day for each day that a person is in violation of § 14–603 of this subtitle.
(d)    This section does not limit any regulatory power of the Commissioner under this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-101 - Scope of Title

This title does not apply to:
(1)    a policy of liability or workers’ compensation and employer’s liability insurance;
(2)    a group or blanket policy, except as otherwise provided in this title;
(3)    reinsurance; or
(4)    a life insurance, endowment, or annuity contract, or contract supplemental to a life insurance, endowment, or annuity contract that contains only those provisions relating to health insurance that:
(i)    provide additional benefits in case of dismemberment, loss of sight, or death by accident or accidental means;
(ii)    provide additional benefits for long-term home health care and long-term care in a nursing home or other related institution; or
(iii)    operate to safeguard the contract or supplemental contract against lapse or to provide a special surrender value, special benefit, or annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-102 - Third-Party Ownership of Policies

In this title, the word “insured” may not be construed to prevent a person other than the insured with a proper insurable interest from applying for and owning a policy covering the insured or from being entitled under that policy to any indemnities, benefits, and rights provided in the policy.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-103 - Simplified Language Required

(a)    An insurer or nonprofit health service plan may not issue or deliver in the State an individual health insurance policy, or group health insurance policy covering a group of 1,000 lives or less, unless the policy or certificate is:
(1)    written in simplified language; and
(2)    approved by the Commissioner as complying with the simplified language standards adopted under subsection (c) of this section.
(b)    Subsection (a) of this section applies:
(1)    on or after January 2, 1992; or
(2)    on or after July 2, 1997, if the policy or certificate was approved by the Commissioner on or before January 1, 1992.
(c)    To establish simplified language standards for individual and group health insurance policies and certificates subject to this section, the Commissioner shall adopt regulations that are consistent with the Life and Health Insurance Policy Language Simplification Model Act adopted by the National Association of Insurance Commissioners.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-104 - Nonduplication and Coordination Provisions in Policies

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Intensive care policy” means a health insurance policy that provides benefits only for treatment received in the specifically designated facility of a hospital that provides the highest level of care and is restricted to patients who are physically and critically ill or injured.
(3)    “Specified disease policy” has the meaning stated in § 15-109 of this subtitle.
(b)    In accordance with regulations that the Commissioner adopts, the Commissioner shall allow health insurance policies and policies of nonprofit health service plans to contain nonduplication provisions or provisions to coordinate coverage with:
(1)    other health insurance policies, including commercial individual, group, and blanket policies and policies of nonprofit health service plans;
(2)    subscriber contracts that are issued by health maintenance organizations; and
(3)    other established programs under which the insured may make a claim.
(c)    Notwithstanding subsection (b) of this section or any other provision of this article, an individual, group, or blanket health insurance policy, nonprofit health insurance policy, or nonprofit health service plan may not contain a nonduplication provision or provision to coordinate coverage with an individually underwritten and issued, guaranteed renewable, specified disease policy or intensive care policy, that does not provide benefits on an expense-incurred basis.
(d)    Health insurance policies and policies of nonprofit health service plans may not contain a provision that requires personal injury protection benefits under a motor vehicle liability insurance policy to be paid before benefits under the policies.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-105 - Coverage Information About Breast Implants

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Breast implant” means a pocket or envelope that is surgically inserted under the skin and contains soft silicone gel, saline solution, or a combination of soft silicone gel and saline solution.
(3)    “Breast implant-related condition” means a condition that the federal Food and Drug Administration recognizes as possibly linked to breast implants.
(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 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 information to the Commissioner about the entity’s:
(1)    coverage for breast implant removals and breast implant-related conditions; and
(2)    preexisting condition provisions in policies for individuals with breast implants.
(d)    (1)    On request, the Commissioner shall make available to consumers and licensed physicians the information collected under subsection (c) of this section.
(2)    When providing the information, the Commissioner may include a statement that the Commissioner does not guarantee the accuracy of the information.
(3)    The Commissioner may set a fee to cover the cost of providing the information under paragraph (1) of this subsection.
(e)    A licensed physician may make available to a patient the information obtained from the Commissioner under subsection (d) of this section.
(f)    The Commissioner shall adopt regulations to carry out this section, including regulations that determine the extent and format of the information required under subsection (c) of this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-106 - Home Medical Equipment

(a)    (1)    An insurer under a contract that provides an individual with home medical equipment pursuant to an individual, group, or blanket health insurance policy or certificate that is delivered or issued for delivery in the State and that provides benefits on an expense-incurred basis:
(i)    shall pay the home medical equipment provider directly if the insured has executed an assignment of benefits; and
(ii)    subject to the copayment and deductible provisions in the insurance contract, may not require the home medical equipment provider to accept less than the agreed monthly rental amount for each month in which benefits are payable under the insurance contract.
(2)    A nonprofit health service plan under a contract that provides a subscriber with home medical equipment pursuant to a health insurance policy or certificate that is delivered or issued for delivery in the State and that provides benefits on an expense-incurred basis:
(i)    shall pay the home medical equipment provider directly if the contract, policy, or certificate of insurance provides for direct payment;
(ii)    may pay the home medical equipment provider or the subscriber receiving the home medical equipment, if the contract, policy, or certificate of insurance does not require direct payment; and
(iii)    may not require the home medical equipment provider to accept less than the agreed monthly rental amount for each month that use of the home medical equipment is authorized by the nonprofit health service plan.
(b)    Authorization may not be terminated until both the provider and beneficiary of the home medical equipment have been notified that authorization is terminated.
(c)    (1)    Rented home medical equipment and services may be purchased with the consent of the provider and insurer if:
(i)    on the insurer’s request either before the initial election to rent the equipment or on the insurer’s receipt of the initial claim from the provider, the purchase price and rental price of the equipment were disclosed to the insurer; and
(ii)    there is no material change in the medical condition of the insured, as certified by the attending physician.
(2)    Rented home medical equipment and services may be purchased with the consent of the provider and nonprofit health service plan in accordance with the benefits available under the applicable health insurance policy or certificate.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-107 - Notice to Pharmacies of Change in Pharmaceutical Benefits

(a)    This section applies to insurers and nonprofit health service plans that issue or deliver individual, group, or blanket health insurance policies in the State.
(b)    At least 30 days before the change is effective, an entity subject to this section that provides pharmaceutical benefits shall notify in writing all pharmacies under contract with the entity of any of the following changes in the pharmaceutical benefit program rules or requirements:
(1)    exclusion of coverage for classes of drugs as specified by the contract;
(2)    changes in prior or preauthorization procedures; or
(3)    selection of new prescription claims processors.
(c)    An entity subject to this section that fails to provide advance notice under subsection (b) of this section shall honor and pay in full any claim under the program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-108 - Record Keeping Procedures

Each insurer that issues or delivers individual, group, or blanket health insurance policies in the State shall establish record keeping procedures that allow review for overutilization and abuse of the use of hospital, health, and medical services that may result from the actions or activities of the policyholders or certificate holders of the insurer or the providers of hospital, health, and medical services to the insured individuals.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-109 - Minimum Loss Ratio for Specified Disease Policies

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Loss ratio” means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State.
(3)    “Specified disease policy” means a health insurance policy that provides:
(i)    benefits only for a disease or diseases specified in the policy or for a treatment unique to a specified disease or diseases; or
(ii)    additional benefits for a disease or diseases specified in the policy or for treatment unique to a specified disease or diseases.
(b)    This section applies to each individual, group, or blanket health insurance policy or nonprofit health service plan that is issued or delivered in the State.
(c)    To administer §§ 12-203, 12-204, and 12-205 of this article, the Commissioner shall establish a minimum loss ratio in accordance with generally accepted actuarial principles with respect to specified disease policies.