reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-04 - Criteria for Health Benefit Plans -- Consistent With Federal Law

For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish criteria that a health benefit plan must meet to be considered a health benefit plan that covers essential health benefits; and
(2)    are consistent with 45 C.F.R. Part 156 Subpart B and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-05 - Application to Grandfathered Plans -- Prohibition on Certain Exclusions or Denials

(a)    This section applies to all grandfathered plans except grandfathered plans that are individual plans and to every health benefit plan that is not a grandfathered plan.
(b)    A carrier may not:
(1)    exclude or limit benefits because a health condition was present before the effective date of coverage; or
(2)    deny coverage because a health condition was present before or on the date of denial.
(c)    The prohibition in subsection (b) of this section applies whether or not:
(1)    any medical advice, diagnosis, care, or treatment was recommended or received for the condition; or
(2)    the health condition was identified as a result of:
(i)    a pre–enrollment questionnaire or physical examination given to an individual; or
(ii)    a review of records relating to the pre–enrollment period.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-06 - Certain Factors Prohibited in Consideration -- Extra Premiums Prohibited

(a)    A carrier may not establish rules for eligibility, including continued eligibility, for enrollment of an individual into a health benefit plan based on health status–related factors, including:
(1)    health condition;
(2)    claims experience;
(3)    receipt of health care;
(4)    medical history;
(5)    genetic information;
(6)    evidence of insurability including conditions arising out of acts of domestic violence; or
(7)    disability.
(b)    A carrier may not require an individual, as a condition of enrollment or continued enrollment in a health benefit plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the health benefit plan on the basis of any health status–related factor in relation to the individual or to an individual enrolled under the health benefit plan as a dependent of the individual.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-07 - Premium Rates Review -- Basis -- Ratio of Premium Rate Variation

(a)    (1)    This section may not be construed to limit the authority of the Commissioner to conduct a health benefit plan premium rate review under Title 11, Subtitle 6 of this article.
(2)    This section applies only to a carrier offering an individual plan and, subject to § 15–1205 of this title, a carrier offering a small group plan.
(b)    A carrier may determine a premium rate based on:
(1)    subject to subsection (c) of this section, age;
(2)    geography based on the following contiguous areas of the State:
(i)    the Baltimore metropolitan area;
(ii)    the District of Columbia metropolitan area;
(iii)    Western Maryland; and
(iv)    Eastern Maryland and Southern Maryland;
(3)    subject to subsection (d) of this section, whether the plan covers an individual or a family; and
(4)    subject to subsection (e) of this section, tobacco use.
(c)    (1)    In this subsection, “age” means an individual’s age as of the date of issuance or renewal of a health benefit plan.
(2)    For individuals who are 21 years of age or older, a premium rate based on age:
(i)    may not vary by more than a ratio of 3 to 1 for adults;
(ii)    shall provide for 1–year age bands for individuals at least 21 years old and under the age of 64 years; and
(iii)    shall provide for a single age band for individuals at least 64 years old.
(3)    For individuals who are under the age of 21 years, a premium rate based on age shall:
(i)    be actuarially justified and consistent with the uniform age rating curve established in accordance with paragraph (4) of this subsection;
(ii)    provide for a single age band for individuals under the age of 15 years; and
(iii)    provide for 1–year age bands for individuals at least 15 years old and under the age of 20 years.
(4)    The uniform age rating curve required under paragraph (3)(i) of this subsection may be established by the Commissioner in the individual market, small group market, or both markets.
(d)    (1)    A rating variation for a health benefit plan that provides coverage for a family shall be applied based on the portion of the premium attributable to each family member covered.
(2)    (i)    Subject to subparagraph (ii) of this paragraph, a premium for a health benefit plan that provides coverage for a family shall be determined by summing the premiums for each individual family member.
(ii)    For a health benefit plan that provides family coverage for individuals under the age of 21 years, the sum shall include not more than the premiums for the three oldest individuals under the age of 21 years.
(e)    A premium rate based on tobacco use may not vary by more than a ratio of 1.5 to 1.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-08 - Coverage Available for Dependent Child Until Age of 26 Years -- Relationship to Insured

(a)    A carrier that offers a health benefit plan, including a grandfathered plan, that provides for dependent coverage of a child shall continue to make the coverage available for the child until the child is 26 years old.
(b)    A carrier may not establish rules for eligibility, including continued eligibility, for coverage of a child under the age of 26 years based on any factor other than the relationship between the child and the insured.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-09 - Acceptance of All Employers and Individuals -- Exceptions

(a)    Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article:
(1)    Subtitle 4 of this title;
(2)    §§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title;
(3)    §§ 15–1316 and 15–1318 of this title; and
(4)    §§ 15–1406 and 15–1406.1 of this title.
(b)    (1)    Except as provided in paragraph (2) of this subsection, a carrier may restrict enrollment to open or special enrollment periods.
(2)    A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year.
(c)    If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier:
(1)    (i)    may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and
(ii)    if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or
(2)    may deny coverage within a service area if the carrier:
(i)    demonstrates to the Commissioner that:
1.    the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and
2.    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and
(ii)    does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area.
(d)    A carrier may deny coverage if the carrier:
(1)    demonstrates to the Commissioner that:
(i)    the carrier does not have the financial reserves necessary to underwrite additional coverage; and
(ii)    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and
(2)    unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-10 - Coverages Required and Additional Charges Prohibited -- Out-of-Network Charges -- Services Recommended or Not by Task Force

(a)    Except as provided in subsections (b) and (c) of this section, a carrier shall provide coverage for and may not impose any cost–sharing requirements, including copayments, coinsurance, or deductibles for:
(1)    evidence–based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force with respect to the individual involved;
(2)    immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved, if the recommendation:
(i)    has been adopted by the Director of the Centers for Disease Control and Prevention; and
(ii)    is listed on the Immunization Schedules of the Centers for Disease Control and Prevention for routine use;
(3)    with respect to infants, children, and adolescents, evidence–informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and
(4)    with respect to women:
(i)    to the extent not provided in item (ii) of this item, preventive care and screenings as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of § 2713(a)(4) of the federal Public Health Service Act; and
(ii)    subject to  § 15–826(c) of this title, contraceptive coverage as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of § 2713(a)(4) of the federal Public Health Service Act.
(b)    To the extent that cost–sharing is otherwise allowed under federal or State law, a health benefit plan that uses a network of providers may impose cost–sharing requirements on the coverage described in subsection (a) of this section for items or services delivered by an out–of–network provider.
(c)    This section may not be construed to prohibit a carrier from providing coverage for services in addition to those recommended by the United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-11 - Lifetime or Annual Limits on Benefits

(a)    Except as provided in subsections (b) and (c) of this section, a carrier that offers a health benefit plan, including a grandfathered plan, may not establish lifetime limits or annual limits on the dollar value of benefits for any insured individual.
(b)    To the extent that limits are otherwise authorized under federal or State law, a carrier may establish annual limits on the dollar value of benefits for an insured individual for a grandfathered plan that is an individual plan.
(c)    This section may not be construed to prohibit a carrier from placing annual or lifetime per beneficiary limits on specific covered benefits that are not essential health benefits.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-13 - Identification of Participating Primary Care Provider -- Children -- Obstetrical or Gynecological Care

(a)    If a carrier requires or provides for the designation of a participating primary care provider for an insured individual, the carrier shall allow each insured individual to designate any participating primary care provider if the provider is available to accept the insured individual.
(b)    (1)    (i)    This subsection applies only to an individual who has a child who is an insured individual under the individual’s health benefit plan.
(ii)    This subsection may not be construed to waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of pediatric care.
(2)    If a carrier requires or provides for the designation of a participating primary care provider for a child, the carrier shall allow the individual to designate any participating physician who specializes in pediatrics as the child’s primary care provider if the provider is available to accept the child.
(c)    (1)    (i)    This subsection applies only to a carrier that:
1.    provides coverage for obstetrical or gynecological care; and
2.    requires the designation by an insured individual of a participating primary care provider.
(ii)    This subsection may not be construed to:
1.    waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of obstetrical or gynecological care; or
2.    prohibit a carrier from requiring that the obstetrical or gynecological provider notify the primary care provider or carrier for an insured individual of treatment decisions.
(2)    A carrier shall treat the provision of obstetrical and gynecological care and the ordering of related obstetrical and gynecological items and services by a participating health care provider that specializes in obstetrics or gynecology as care authorized by the primary care provider for the insured individual.
(3)    A carrier may not require authorization or referral by any person, including the primary care provider for the insured individual, for an insured individual who seeks coverage for obstetrical or gynecological care provided by a participating health care provider who specializes in obstetrics or gynecology.
(4)    A health care provider that provides obstetrical or gynecological care shall comply with a carrier’s policies and procedures.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-16 - Acceptable Medical Loss Ratio -- Calculation

(a)    (1)    For purposes of this section, “medical loss ratio”:
(i)    has the meaning established in 45 C.F.R. § 158.221; or
(ii)    if the Commissioner adopts regulations as described in paragraph (2) of this subsection, has the meaning established by the adopted regulations.
(2)    To the extent necessary, the Commissioner shall adopt regulations that:
(i)    establish a definition for “medical loss ratio”; and
(ii)    are consistent with 45 C.F.R. § 158.221 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
(b)    This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan.
(c)    The minimum acceptable medical loss ratio is:
(1)    for the large group market, 85% or a higher percentage as determined by the Commissioner in regulations; and
(2)    for the small group market and individual market, 80% or a higher percentage as determined by the Commissioner in regulations.
(d)    (1)    Except as provided in paragraph (2) of this subsection, each carrier shall comply with the requirements for calculating medical loss ratios and related reporting and rebate requirements established in 45 C.F.R. Part 158 and any corresponding federal rules and guidance.
(2)    If the Commissioner adopts regulations as described in subsection (e) of this section, each carrier shall comply with the requirements in the adopted regulations.
(e)    To the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish requirements for calculating medical loss ratios and related reporting and rebate requirements; and
(2)    are consistent with 45 C.F.R. Part 158 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-17 - Required Information Provided by Carrier -- Disclosures -- Hardship Exemptions -- Catastrophic Plans

(a)    (1)    This section may not be construed to require a carrier to disclose information that is proprietary and trade secret information under applicable law.
(2)    This section applies only to carriers offering an individual plan or a small group plan.
(b)    A carrier shall disclose to an individual or employer, as applicable, the following information:
(1)    the carrier’s right to change premium rates and the factors that may affect changes in premium rates; and
(2)    the benefits and premiums available under all health benefit plans for which the employer or individual is qualified.
(c)    The carrier shall make the disclosure required under subsection (b) of this section:
(1)    as part of its solicitation and sales material; or
(2)    if the information is requested by the individual or employer.
(d)    Information disclosed in accordance with subsection (b) of this section shall be:
(1)    provided in a manner determined to be understandable by the average employer or individual; and
(2)    sufficient to reasonably inform the employer or individual of the employer’s or individual’s rights and obligations under the health benefit plan.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-18 - Catastrophic Plans -- Regulations Governing

(a)    A carrier may offer a catastrophic plan in the individual market in accordance with the requirements of this section.
(b)    A catastrophic plan may be offered only to individuals who:
(1)    are under the age of 30 years before the beginning of the plan year; or
(2)    hold certification for a hardship exemption or an affordability exemption as required in subsection (c) of this section.
(c)    (1)    Except as provided in paragraph (2) of this subsection, to be offered a catastrophic plan, an individual shall hold certification for a hardship exemption or an affordability exemption under 42 U.S.C. § 5000A.
(2)    If the Maryland Health Benefit Exchange adopts regulations as described under subsection (d) of this section, an individual shall hold certification for a hardship exemption or an affordability exemption under the regulations adopted by the Exchange.
(d)    To the extent necessary, the Maryland Health Benefit Exchange shall adopt regulations that:
(1)    establish a process for issuing hardship exemptions and affordability exemptions; and
(2)    are consistent with 42 U.S.C. § 5000A and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
(e)    (1)    Subject to paragraph (2) of this subsection, a catastrophic plan shall provide coverage for essential health benefits.
(2)    A catastrophic plan shall require a deductible that:
(i)    is equal to the annual limit on cost–sharing described in § 15–1A–19 of this subtitle;
(ii)    applies to essential health benefits;
(iii)    does not apply to at least three primary care visits each plan year; and
(iv)    does not apply to any covered benefits for which a deductible is prohibited under this title.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-19 - Annual Limitations on Cost Sharing for Essential Health Benefits Covered -- Regulations

(a)    (1)    In this section, “cost–sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits.
(2)    “Cost–sharing” includes:
(i)    deductibles, coinsurance, copayments, or similar charges; and
(ii)    any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to essential health benefits covered under the plan.
(3)    “Cost–sharing” does not include premiums, balance billing amounts for nonnetwork providers, or spending for noncovered services.
(b)    (1)    Except as provided in paragraph (2) of this subsection, each carrier shall comply with annual limitations on cost–sharing for essential health benefits covered under health benefit plans as established by 45 C.F.R. § 156.130.
(2)    If the Commissioner adopts regulations as described in subsection (c) of this section, each carrier shall comply with the adopted regulations.
(c)    To the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish annual limitations on cost–sharing; and
(2)    are consistent with 45 C.F.R. § 156.130 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-20 - Prescription Drug Essential Health Benefits for Individual and Small Group Plans

(a)    (1)    This section applies only to individual plans and small group plans.
(2)    The requirements in this section are in addition to and not in substitution of any other requirements of law related to prescription drug benefits.
(b)    (1)    Except as provided in paragraph (2) of this subsection, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with 45 C.F.R. § 156.122.
(2)    If the Commissioner adopts regulations as described in subsection (c) of this section, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with the regulations adopted by the Commissioner.
(c)    To the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish criteria to determine whether an individual plan or a small group plan provides prescription drug essential health benefit coverage; and
(2)    are consistent with 45 C.F.R. § 156.122 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-21 - Rescission of Coverage Under Health Benefit Plans -- Exceptions

(a)    This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan.
(b)    (1)    Subject to § 15–1106 of this title, a carrier may not rescind the coverage under a health benefit plan unless:
(i)    the insured individual performs an act, a practice, or an omission that constitutes fraud or makes a misrepresentation of material fact as prohibited by the health benefit plan; and
(ii)    except as provided in paragraph (2) of this subsection, the carrier complies with 45 C.F.R. § 147.128.
(2)    If the Commissioner adopts regulations as described in subsection (c) of this section, a carrier that rescinds the coverage under a health benefit plan in accordance with subsection (b) of this section shall comply with the adopted regulations.
(c)    To the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish requirements that a carrier shall comply with to rescind coverage under subsection (b) of this section; and
(2)    are consistent with 45 C.F.R. § 147.128 and any federal rules and guidance as those provisions were in effect December 1, 2019.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-22 - Carriers May Refuse or Deny Coverage for Non-Discriminatory Reasons -- Discrimination Based on Sexual Orientation or Gender Identity Prohibited

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Gender identity” has the meaning stated in § 20–101 of the State Government Article.
(3)    “Sexual orientation” has the meaning stated in § 20–101 of the State Government Article.
(b)    This section does not prohibit a carrier from refusing, withholding, or denying coverage under a health benefit plan to any individual for failure to conform to the usual and regular requirements, standards, and regulations of the carrier, unless the denial is based on discrimination on the grounds of race, sex, color, creed, national origin, marital status, sexual orientation, age, gender identity, or disability.
(c)    This section does not apply to limitations or restrictions related to age or marital status that are specifically authorized or required under this article to limit or restrict eligibility for insurance coverage or benefits.
(d)    A carrier may not refuse, withhold, or deny any individual coverage under a health benefit plan offered by the carrier or otherwise discriminate against any individual because of the individual’s race, sex, creed, color, national origin, marital status, sexual orientation, age, gender identity, or disability.
(e)    The Commission on Civil Rights shall enforce the provisions of this section as provided for in § 2–202 of this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-202 - Language and Order of Policy Provisions

(a)    Except as otherwise provided in this section, each policy of health insurance that is delivered or issued for delivery in the State:
(1)    shall contain the exact language of each provision that is required under §§ 15-207 through 15-218 of this subtitle and any optional provision in §§ 15-207 through 15-226 of this subtitle that is used; and
(2)    shall contain each mandatory provision and any optional provision that is used:
(i)    in the order in which those provisions appear in this subtitle; or
(ii)    as individual items in any part of the policy with other provisions to which they may be logically related, if the resulting policy is not wholly or partly unintelligible, uncertain, or likely to mislead a person to whom the policy is offered, delivered, or issued.
(b)    The insurer may substitute a corresponding provision with different wording for a provision set forth in this subtitle if the corresponding provision is approved by the Commissioner and is not less favorable in any respect to the insured or beneficiary.
(c)    If a provision specified in §§ 15-207 through 15-218 of this subtitle is wholly or partly inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the Commissioner, shall:
(1)    omit from the policy the inapplicable provision or part of the provision; or
(2)    modify the inconsistent provision or part of the provision to make it consistent with the coverage provided by the policy.
(d)    Each provision shall be preceded individually by the applicable caption shown or, at the option of the insurer, by an appropriate individual or group caption or subcaption that the Commissioner approves.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-203 - Right to Refuse Renewal

Other than a policy of accident only insurance, each policy of health insurance in which the insurer reserves the right to refuse renewal on an individual basis shall contain a provision, endorsement, or rider that provides in substance:
(1)    that, subject to the right to terminate the policy on nonpayment of premium when due, the right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the policy;
(2)    that a refusal to renew shall be without prejudice to any claim that originates while the policy is in effect;
(3)    that a renewal may not be refused solely because of a change in the health or physical or mental condition of the insured; and
(4)    unless omitted at the insurer’s option, that the right to refuse renewal of a policy of health insurance that was reinstated after lapse may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-204 - Age Limit; Misstatement of Age

(a)    If a policy of health insurance establishes, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and the date falls within a period for which the insurer accepts a premium for the policy, or if the insurer accepts a premium for the policy after that date, the coverage provided by the policy continues in effect until the end of the period for which the insurer has accepted the premium.
(b)    If the age of the insured is misstated and, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased before the acceptance of a premium for the policy, the liability of the insurer is limited to the refund, on request, of the premiums paid for the period not covered by the policy.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-205 - Policies of Foreign or Alien Insurers; Policies of Domestic Insurers

(a)    A policy of a foreign insurer or alien insurer that is delivered or issued for delivery in the State may contain a provision that:
(1)    is not less favorable to the insured or beneficiary than the provisions of this subtitle; and
(2)    is required by the law of the state or country under which the foreign insurer or alien insurer is organized.
(b)    A policy of a domestic insurer that is issued for delivery in another state or country may contain a provision that is allowed or required by the laws of the other state or country.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-206 - Policies and Provisions at Variance With Subtitle

(a)    A policy provision that is not subject to this subtitle may not make the policy or any part of the policy less favorable in any respect to the insured or beneficiary than the provisions of the policy that are subject to this subtitle.
(b)    A policy that is delivered or issued for delivery in the State in violation of this subtitle is valid but shall be construed as provided in this subtitle.
(c)    Whenever a policy provision that is subject to this subtitle conflicts with a provision of this subtitle, the rights, duties, and obligations of the insurer, insured, and beneficiary shall be governed by this subtitle.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-207 - Entire Contract; Changes

Each policy of health insurance shall contain the following provision:
“Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No insurance producer has authority to change this policy or to waive any of its provisions.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-208 - Time Limit on Specified Defenses

(a)    Except as provided in subsection (c) of this section, each policy of health insurance shall contain the following provision:
“Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such two-year period.”
(2)    “No claim for loss incurred or disability (as defined in the policy) commencing after two years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.”
(b)    The first provision set forth in subsection (a) of this section does not:
(1)    affect a legal requirement for avoidance of a policy or denial of a claim during the initial two-year period after the issuance of the policy; or
(2)    limit the application of §§ 15-219 through 15-223 of this subtitle if there is a misstatement with respect to age, occupation, or other insurance.
(c)    (1)    This subsection applies only to a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:
(i)    until the insured is at least 50 years old; or
(ii)    if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.
(2)    A policy subject to this subsection may omit the first provision set forth in subsection (a) of this section and substitute the following provision under the caption “incontestable”:
“After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.”
(3)    In the provision set forth in paragraph (2) of this subsection, an insurer may omit the clause “excluding any period during which the insured is disabled”.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-209 - Grace Period

(a)    (1)    Subject to subsection (b) of this section, each policy of health insurance shall contain the following provision:
“Grace period: A grace period of ........ (insert a number not less than ‘7’ days for weekly premium policies, ‘10’ days for monthly premium policies and ‘31’ days for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period this policy shall continue in force.”
(2)    A policy shall provide a grace period of 31 days if the policy:
(i)    allows the policyholder to choose any one of two or more modes of premium payment by remitting an amount stated in the policy for that particular mode of payment; and
(ii)    does not require a formal request by the policyholder to change the mode of premium payment.
(b)    A policy in which the insurer reserves the right to refuse renewal shall state the following provision at the beginning of the provision set forth in subsection (a)(1) of this section:
“Unless not less than thirty days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-210 - Reinstatement

(a)    Each policy of health insurance shall contain the following provision:
“Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurer or such insurance producer requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth (45th) day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty (60) days prior to the date of reinstatement.”
(b)    The last sentence of the provision set forth in subsection (a) of this section may be omitted from 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.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-211 - Notice of Claim

(a)    Each policy of health insurance shall contain the following provision:
“Notice of claim: Written notice of claim must be given to the insurer within twenty (20) days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at .......... (insert the location of such office as the insurer may designate for the purpose), or to any authorized insurance producer of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.”
(b)    In a policy that provides a loss-of-time benefit that may be payable for at least 2 years, an insurer may insert the following provision between the first and second sentences of the provision set forth in subsection (a) of this section:
“Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall, at least once in every six (6) months after having given notice of the claim, give to the insurer notice of continuance of the disability, except in the event of legal incapacity. The period of six (6) months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured’s right to any indemnity which would otherwise have accrued during the period of six (6) months preceding the date on which such notice is actually given.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-212 - Claim Forms

Each policy of health insurance shall contain the following provision:
“Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-213 - Proofs of Loss

Except as provided in § 12–102(c) of this article, each policy of health insurance shall contain the following provision:
“Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety (90) days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-214 - Time of Payment of Claims

(a)    Each policy of health insurance shall contain the following provision:
“Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment, will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ........ (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.”
(b)    A policy is considered to provide for periodic payment for loss only if the policy contains a specific statement to that effect.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-215 - Payment of Claims

(a)    Each policy of health insurance shall contain the following provision:
“Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured’s death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured.”
(b)    (1)    At the option of the insurer, a policy may include either or both of the provisions set forth in paragraphs (2) and (3) of this subsection with the provision set forth in subsection (a) of this section.
(2)    “If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is under eighteen years of age or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $ .......... (insert an amount which shall not exceed $1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment.”
(3)    “Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical or surgical services may, at the insurer’s option and unless the insured requests otherwise in writing not later than the time of filing proof of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-216 - Physical Examinations and Autopsy

Each policy of health insurance shall contain the following provision:
“Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-217 - Time for Bringing Legal Actions

Each policy of health insurance shall contain the following provision:
“Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three (3) years after the written proof of loss is required to be furnished.”
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-218 - Change of Beneficiary

(a)    Subject to subsection (b) of this section, each policy of health insurance shall contain the following provision:
“Change of beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change a beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.”
(b)    An insurer may choose to omit from the provision set forth in subsection (a) of this section the clause:
“Unless the insured makes an irrevocable designation of beneficiary”.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 2 - Individual Health Insurance Policy Forms and Provisions › Section 15-219 - Change of Occupation

A policy of health insurance may contain the following provision:
“Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence or the loss for which the insurer is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation.”