reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.08 - Form of Opt Out Notice to Consumers and Opt Out Methods

Current through Register Vol. 51, No. 14, July 12, 2024
A. Opt Out Notice Requirements.
(1) A licensee required to provide an opt out notice under Regulation .11A of this chapter shall provide a clear and conspicuous notice to each of the licensee's consumers that accurately explains the right to opt out under that regulation.
(2) A right to opt out notice required to be provided under §A(1) of this regulation shall state:
(a) That the licensee discloses or reserves the right to disclose nonpublic personal financial information about its consumer to a nonaffiliated third party;
(b) That the consumer has the right to opt out of that disclosure; and
(c) A reasonable means by which the consumer may exercise the opt out right.
(3) A licensee provides adequate notice that the consumer can opt out of the disclosure of nonpublic personal financial information to a nonaffiliated third party if the licensee:
(a) Identifies all categories of nonpublic personal financial information that it discloses or reserves the right to disclose;
(b) Identifies all of the categories of nonaffiliated third parties to which the licensee discloses the information as described in Regulation .07A(2) and (3) of this chapter;
(c) States that the consumer can opt out of the disclosure of the nonpublic personal financial information; and
(d) Identifies the insurance products or insurance services that the consumer obtains from the licensee to which the opt out would apply.
(4) A licensee provides a reasonable means to exercise an opt out right if the licensee:
(a) Designates check-off boxes in a prominent position on the relevant forms with the opt out notice;
(b) Includes a reply form together with the opt out notice;
(c) Provides an electronic means to opt out that includes the form required under §A(4)(b) of this regulation that can be sent via electronic mail or a process at the licensee's web site, if the consumer agrees to the electronic delivery of information; or
(d) Provides a toll-free telephone number that consumers may call to opt out.
(5) A licensee does not provide a reasonable means to exercise an opt out right if:
(a) The only means of opting out is for the consumer to write the consumer's own letter to exercise that opt out right; or
(b) The only means of opting out as described in any notice subsequent to the initial notice is to use a check-off box that the licensee provided with the initial notice but did not include with the subsequent notice.
(6) A licensee may require each consumer to opt out through a specific means, as long as that means is reasonable for that consumer.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.09 - Revised Privacy Notices for Financial Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as otherwise authorized in this chapter, a licensee may not, directly or through an affiliate, disclose any nonpublic personal financial information about a consumer to a nonaffiliated third party other than as described in the initial notice that the licensee provided to that consumer under Regulation .05 of this chapter, unless:
(1) The licensee has provided to the consumer a clear and conspicuous revised notice that accurately describes its policies and practices;
(2) The licensee has provided to the consumer a new opt out notice;
(3) The licensee has given the consumer a reasonable opportunity, before the licensee discloses the information to the nonaffiliated third party, to opt out of the disclosure; and
(4) The consumer does not opt out.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.10 - Delivery of Privacy Notices for Financial Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. Manner of Delivery.
(1) A licensee required to provide a notice under this chapter shall provide any notice required by this chapter so that each consumer can reasonably be expected to receive actual notice in writing or, if the consumer agrees, electronically.
(2) A licensee may reasonably expect that a consumer will receive actual notice if the licensee:
(a) Hand-delivers a printed copy of the notice to the consumer;
(b) Mails a printed copy of the notice to the last-known address of the consumer separately, or in a policy, billing, or other written communication;
(c) For a consumer who conducts transactions electronically, posts the notice on the electronic site and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining a particular insurance product or insurance service; or
(d) For an isolated transaction with a consumer, such as the licensee providing an insurance quote or selling the consumer travel insurance, posts the notice and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining the particular insurance product or insurance service.
(3) A licensee fails to meet the requirements of §A(1) of this regulation if the licensee:
(a) Only posts a sign in its office or generally publishes advertisements of its privacy policies and practices; or
(b) Sends the notice via electronic mail to a consumer who does not obtain an insurance product or insurance service from the licensee electronically.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.11 - Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as otherwise authorized in this chapter, a licensee may not, directly or through an affiliate, disclose nonpublic personal financial information about a consumer to a nonaffiliated third party unless:
(1) The licensee has provided to the consumer an initial notice as required under Regulation .05 of this chapter;
(2) The licensee has provided to the consumer an opt out notice as required in Regulation .08 of this chapter;
(3) The licensee has given the consumer a reasonable opportunity, before it discloses the information to the nonaffiliated third party, to opt out of the disclosure; and
(4) The consumer does not opt out.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.12 - Limits on Redisclosure and Reuse of Nonpublic Personal Financial Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution under an exception in Regulation .15 or .16 of this chapter, the licensee's disclosure and use of that information is limited as follows:
(1) The licensee may disclose the information to the affiliates of the financial institution from which the licensee received the information;
(2) The licensee may disclose the information to its affiliates, but the licensee's affiliates may, in turn, disclose and use the information only to the extent that the licensee may disclose and use the information; and
(3) The licensee may disclose and use the information pursuant to an exception in Regulation .15 or .16 of this chapter, in the ordinary course of business to carry out the activity covered by the exception under which the licensee received the information.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.13 - Limits on Sharing Account Number Information for Marketing Purposes

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope. This regulation does not apply to the disclosure of a policy number, or similar form of access number or access code, that is in an encrypted form, as long as the licensee does not provide the recipient with a means to decode the number or code.
B. Policy or Transaction Account Defined.
(1) In this regulation, the following term has the meaning indicated.
(2) Term Defined.
(a) "Policy or transaction account" means an account other than a deposit account or a credit card account.
(b) "Policy or transaction account" does not include an account to which third parties cannot initiate charges.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.14 - Exception to Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this regulation, "joint agreement" means a written contract pursuant to which a licensee and one or more financial institutions jointly offer, endorse, or sponsor a financial product or financial service.
B. The opt out requirements in Regulations .08 and .11 of this chapter do not apply when a licensee provides nonpublic personal financial information to a nonaffiliated third party to perform services for the licensee or functions on the licensee's behalf, if the licensee:
(1) Provides the initial notice in accordance with Regulation .05 of this chapter; and
(2) Enters into a contractual agreement with the third party that prohibits the third party from disclosing or using the information other than to carry out the purposes for which the licensee disclosed the information, including use under an exception in Regulation .15 or .16 of this chapter in the ordinary course of business to carry out those purposes.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.15 - Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The requirements for initial notice in Regulation .05A(2) of this chapter, the opt out in Regulations .08 and .11 of this chapter, and service providers and joint marketing in Regulation .14 of this chapter do not apply if the licensee discloses nonpublic personal financial information as necessary to effect, administer, or enforce a transaction that a consumer requests or authorizes, or in connection with:
(1) Servicing or processing an insurance product or insurance service that a consumer requests or authorizes;
(2) Maintaining or servicing the consumer's account with a licensee, or with another entity as part of a private label credit card program or other extension of credit on behalf of that entity;
(3) A proposed or actual securitization, secondary market sale, sales of servicing rights, or similar transaction related to a transaction of the consumer; or
(4) Reinsurance or stop loss or excess loss insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.17 - When Authorization Required for Disclosure of Nonpublic Personal Health Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. A licensee may not disclose nonpublic personal health information about a consumer or customer unless an authorization is obtained from the consumer or customer whose nonpublic personal health information is sought to be disclosed.
B. This regulation does not prohibit, restrict, or require an authorization for the disclosure of nonpublic personal health information by a licensee for the performance of the following insurance functions by or on behalf of the licensee:
(1) Claims administration;
(2) Claims adjustment and management;
(3) Detection, investigation, or reporting of actual or potential fraud, misrepresentation, or criminal activity;
(4) Underwriting;
(5) Policy placement or issuance;
(6) Loss control;
(7) Rate-making and guaranty fund functions;
(8) Reinsurance and excess loss insurance;
(9) Risk management;
(10) Case management;
(11) Disease management;
(12) Quality assurance;
(13) Quality improvement;
(14) Performance evaluation;
(15) Provider credentialing verification;
(16) Utilization review;
(17) Peer review activities;
(18) Actuarial, scientific, medical, or public policy research;
(19) Grievance procedures;
(20) Internal administration of compliance, managerial, and information systems;
(21) Policyholder service functions;
(22) Auditing;
(23) Reporting;
(24) Database security;
(25) Administration of consumer disputes and inquiries;
(26) External accreditation standards;
(27) The replacement of a group benefit plan or workers' compensation policy or program;
(28) Activities in connection with a sale, merger, transfer, or exchange of all or part of a business or operating unit;
(29) Any activity that permits disclosure without authorization pursuant to the federal Health Insurance Portability and Accountability Act privacy rules promulgated by the U.S. Department of Health and Human Services;
(30) Disclosure that is required, or is one of the lawful or appropriate methods, to enforce the licensee's rights or the rights of other persons engaged in carrying out a transaction or providing a product or service that a consumer requests or authorizes;
(31) Any activity otherwise permitted by law, required pursuant to governmental reporting authority, or to comply with legal process; and
(32) Any additional insurance functions determined by the Commissioner to the extent that they are:
(a) Necessary for appropriate performance of insurance functions; and
(b) Fair and reasonable to the interest of consumers.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.18 - Authorizations for Disclosure of Health Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. A valid authorization to disclose nonpublic personal health information pursuant to this regulation shall be in written or electronic form and shall contain all of the following:
(1) The identity of the consumer or customer who is the subject of the nonpublic personal health information;
(2) A general description of the types of nonpublic personal health information to be disclosed;
(3) General descriptions of the parties to whom the licensee discloses nonpublic personal health information, the purpose of the disclosure, and how the information will be used;
(4) The signature of the consumer or customer who is the subject of the nonpublic personal health information or the individual who is legally empowered to grant authority and the date signed; and
(5) Notice of the length of time for which the authorization is valid and that the consumer or customer may revoke the authorization at any time and the procedure for making a revocation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.19 - Authorization Request Delivery

Current through Register Vol. 51, No. 14, July 12, 2024
A. A request for authorization and an authorization form may be delivered to a consumer or a customer as part of an opt out notice pursuant to Regulation .10 of this chapter if the request and the authorization form are clear and conspicuous.
B. An authorization form is not required to be delivered to the consumer or customer or included in any other notices unless the licensee intends to disclose protected health information pursuant to Regulation .17A of this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.20 - Relationship to Federal Rules

Current through Register Vol. 51, No. 14, July 12, 2024
Irrespective of whether a licensee is subject to the federal Health Insurance Portability and Accountability Act privacy rule as promulgated by the U.S. Department of Health and Human Services "Standards for the Privacy of Individually Identifiable Health Information", if a licensee complies with all requirements of the federal rule except for its effective date provision, the licensee is not subject to the provisions of Regulations .17-.19 of this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.21 - Relationship to Maryland Laws

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter does not preempt or supersede existing State law related to medical records, health information privacy, or insurance information privacy.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.22 - Protection of Fair Credit Reporting Act

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter does not modify, limit, or supersede the operation of the federal Fair Credit Reporting Act, 15 U.S.C. §
										1681 et seq., and no inference shall be drawn on the basis of the provisions of this chapter regarding whether information is transaction or experience information under 15 U.S.C. §
										1681a.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.23 - Nondiscrimination

Current through Register Vol. 51, No. 14, July 12, 2024
A licensee may not unfairly discriminate against any consumer or customer because that consumer or customer:
A. Has opted out from the disclosure of his or her nonpublic personal financial information pursuant to the provisions of this chapter; or
B. Has not granted authorization for the disclosure of his or her nonpublic personal health information pursuant to the provisions of this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.08 - Privacy of Consumer Financial and Health Information › Section 31.16.08.24 - Effective Date

Current through Register Vol. 51, No. 14, July 12, 2024
A. By April 1, 2002, a licensee shall provide an initial notice, as required by Regulation .05 of this chapter, to consumers who are the licensee's customers on January 1, 2002.
B. Until July 1, 2002, a contract that a licensee has entered into with a nonaffiliated third party to perform services for the licensee or functions on the licensee's behalf satisfies the provisions of Regulation .14B(2) of this chapter, even if the contract does not include a requirement that the third party maintain the confidentiality of nonpublic personal information, as long as the licensee entered into the agreement on or before July 1, 2000.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter sets forth standards for reporting slavery era insurance information pursuant Insurance Article, Title 30, Annotated Code of Maryland.
B. This chapter requires insurers to provide information and data regarding slavery era insurance to the Maryland Insurance Administration.
C. This chapter specifies how the Administration will distribute to the public the information provided pursuant to §B of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Commissioner" means the Maryland Insurance Commissioner.
(2) "Holding company system" includes:
(a) An insurer that is a member of the holding company system; and
(b) Any other member, subsidiary, or division of the holding company system, in each case regardless of whether it is a licensee.
(3) "Insurer" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(4) "Predecessor insurer" means an insurer associated with the reporting insurer that existed prior in time to the reporting insurer.
(5) "Reporting insurer" has the meaning stated in Insurance Article, §
										30-101, Annotated Code of Maryland.
(6) "Slave" has the meaning stated in Insurance Article, §
										30-101, Annotated Code of Maryland.
(7) "Slaveholder" has the meaning stated in Insurance Article, §
										30-101, Annotated Code of Maryland.
(8) "Slaveholder insurance policies" has the meaning stated in Insurance Article, §
										30-101, Annotated Code of Maryland.
(9) "Slavery era" has the meaning stated in Insurance Article, §
										30-101, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.03 - Reporting Insurers

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer authorized to do business in the State shall file a report to the Commissioner regarding slaveholder insurance policies that it wrote either directly or through a predecessor insurer during the slavery era.
B. If an insurer is a member of a holding company system, a consolidated report may be filed by one insurer in the holding company on behalf of all members of the same holding company that are required to file a report.
C. A consolidated report allowed pursuant to §B of this regulation shall designate one insurer as the reporting insurer for purposes of compliance with this chapter and shall specify which insurers are included in the report.
D. Insurers choosing to file a consolidated report pursuant to §§B and C of this regulation shall comply with all other requirements of this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.04 - Report Format and Content

Current through Register Vol. 51, No. 14, July 12, 2024
A. The report required by Regulation .03A of this chapter shall be filed on letterhead of the insurer, dated, and certified and affirmed under oath by the chief executive officer, or comparable officer, of the insurer as:
(1) Being true and not misleading; and
(2) Containing the most accurate information available at the time of the submission of the report.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.05 - Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each insurer shall file the report required by Regulation .04 of this chapter with the Commissioner on or before October 1, 2011.
B. If the Commissioner determines that a report is incomplete, the Commissioner may require additional reports, as necessary, consistent with the requirements of this chapter.
C. An insurer that files a report indicating that it has information responsive to the relevant statute and this chapter, which has not been provided, shall inform the Commissioner as to the reason that the required information has not been provided and when the required information will be filed.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.06 - Availability of the Slavery Era Insurance Policy Registry and Report

Current through Register Vol. 51, No. 14, July 12, 2024
A. The report generated by the Commissioner pursuant to Insurance Article, Title 30, Annotated Code of Maryland, and this chapter, shall be known as the Slavery Era Insurance Policy Registry and Report.
B. The Commissioner shall provide the Slavery Era Insurance Policy Registry and Report to the Governor and General Assembly on or before April 1, 2012.
C. The Commissioner shall make available to the public a copy of the Slavery Era Insurance Policy Registry and Report on the Maryland Insurance Administration's website.
D. The Slavery Era Insurance Policy Registry and Report shall be accessible to the public at the Thurgood Marshall Law Library at the University Of Maryland School Of Law and any other means that the Commissioner considers appropriate.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.09 - Registry and Report on Slavery Era Insurance › Section 31.16.09.07 - Enforcement

Current through Register Vol. 51, No. 14, July 12, 2024
The Commissioner may impose on an insurer any penalty, sanction, or other form of legal enforcement which the Commissioner has the authority to impose for failure to comply with the provisions of this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter applies to carriers that issue or deliver insurance policies or health maintenance organization contracts in Maryland.
B. This chapter does not apply to complaints filed under Insurance Article, Title 15, Subtitle 10A, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.03 - Complaint investigation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Upon receipt of a complaint, the Commissioner shall begin a complaint investigation.
B. A complaint filed by a health care provider concerning a specific claim under a contract issued or delivered in Maryland by a life insurer, health insurer, nonprofit health service plan, dental plan organization, or health maintenance organization shall be considered to be filed on behalf of the individual who received the health care services for which the claim was filed, unless otherwise specified.
C. The Commissioner shall acknowledge receipt of the complaint by sending a letter or a copy of the correspondence described in §D of this regulation to the complainant and the carrier.
D. If the Commissioner determines information or documentation is needed from a carrier to conduct a complaint investigation, in accordance with Regulation .06 of this chapter:
(1) The Commissioner shall request information or documentation; and
(2) The carrier shall provide the information and documentation by the later of:
(a) 15 working days after receipt of the Commissioner's request; or
(b) The time period specified by the Commissioner in correspondence to the carrier.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.04 - Determination

Current through Register Vol. 51, No. 14, July 12, 2024
A. Upon completion of the complaint investigation, the Commissioner shall document the findings of the complaint investigation in a determination letter and, if applicable, an order.
B. The documented findings of §A of this regulation shall be provided to the complainant and the carrier that was the subject of the complaint.
C. The Commissioner may send the determination letter and, if applicable, the order to the complainant or the carrier by first-class mail or by any other means permitted by law.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.05 - Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
The Commissioner shall report data concerning the outcome of the complaint to the National Association of Insurance Commissioners.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.06 - Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commissioner may request accounts, records, documents, files, logs, photographs, or other information necessary to complete a complaint investigation.
B. Whenever a carrier receives a request from the Commissioner for information and documentation, the carrier shall provide the requested information and documentation:
(1) On the date specified by the Commissioner, unless an extension has been granted by the Commissioner in accordance with §§D and E of this regulation; and
(2) In the manner specified by the Commissioner.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.07 - Commissioner's Actions

Current through Register Vol. 51, No. 14, July 12, 2024
Based on the information or documentation reviewed during a complaint investigation, the Commissioner may, in the Commissioner's sole discretion, take one or more of the following actions in addition to issuing a determination letter or, if applicable, an order:
A. Initiate a market conduct action in accordance with COMAR 31.04.20; or
B. Take any other action authorized by State law.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.08 - Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
If a carrier subject to this chapter fails to provide the information or documentation requested by the Commissioner in accordance with this chapter, the carrier may be subject to an administrative penalty not to exceed $500 per day, in addition to any other sanctions available to the Commissioner.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.09 - Hearings

Current through Register Vol. 51, No. 14, July 12, 2024
A person aggrieved by the determination of the Commissioner's complaint investigation may request a hearing in accordance with the provisions of Insurance Article, §
									2-210(c), Annotated Code of Maryland, and COMAR 31.02.01.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.01 - Plan Administrator Criteria › Section 31.17.01.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes criteria the Board of Directors of the Maryland Health Insurance Plan shall apply to select the Plan Administrator.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.01 - Plan Administrator Criteria › Section 31.17.01.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Administrator" means:
(a) A person that is registered as an Administrator under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland; or
(b) A carrier.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.01 - Plan Administrator Criteria › Section 31.17.01.03 - Selection Criteria for Plan Administrator

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board may select an administrator to be the Plan Administrator only if the administrator:
(1) Satisfies the requirements listed in §§C-I of this regulation; and
(2) Meets all other terms that are established in any contract between the administrator and the Board.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.02 - Medically Uninsurable Individual Based on a Medical or Health Condition › Section 31.17.02.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes the criteria for individuals who have certain medical or health conditions to qualify for coverage under the Maryland Health Insurance Plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.02 - Medically Uninsurable Individual Based on a Medical or Health Condition › Section 31.17.02.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Carrier" means:
(a) An authorized insurer that provides health insurance in the State;
(b) A nonprofit health service plan that is licensed to operate in the State; or
(c) A health maintenance organization that is licensed to operate in the State.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.02 - Medically Uninsurable Individual Based on a Medical or Health Condition › Section 31.17.02.03 - Proof of a Medical or Health Condition

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Plan shall consider that an individual meets the requirements of Regulation .02B(3)(a)(iv) of this chapter if the individual supplies documentation from a licensed physician that states that the individual has a history of or suffers from a medical or health condition.
B. The documentation required in §A of this regulation shall specifically list one of the medical or health conditions in Regulation .02B(2) of this chapter.
C. The documentation required in §A of this regulation may be a letter from a licensed physician.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to describe how the Board of Directors of the Maryland Health Insurance Plan shall operate and administer the Maryland Health Insurance Plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Administrator" means:
(a) A person that is registered as an administrator under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland; or
(b) A carrier.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.03 - Board Meetings

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall meet at the times and places and with the frequency that the Board considers appropriate to conduct the business of the Plan.
B. The Board shall adopt through bylaws the procedures for providing notice of Board meetings.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.04 - Executive Director

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall appoint an Executive Director who shall be the chief administrative officer of the Plan.
B. The Executive Director shall serve at the pleasure of the Board.
C. Under the direction of the Board, the Executive Director shall perform any duty or function that is necessary for the operation of the Plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.05 - Independent Consultants

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board may contract with independent consultants to perform any function that the Board assigns to the consultants, including actuarial analysis and financial analysis.
B. Unless permission is granted specifically by the Board, an independent consultant that contracts with the Board may not release, publish, or otherwise use any information to which the independent consultant had access under its contract with the Board.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.06 - Plan Administrator

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall select a Plan administrator.
B. The Board may select more than one Plan administrator, if the Board decides to contract with different administrators to administer:
(1) Different standard benefit packages;
(2) Specific benefits, such as a prescription drug benefit; or
(3) Specific administrative functions of the Plan, such as case management.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.07 - Hospital Assessments

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each year, the Commission shall calculate the monthly Plan assessment that each hospital shall pay to the Fund.
B. The Commission shall send a billing notice to each hospital for its Plan assessment.
C. Beginning April 1, 2003, each hospital shall forward its monthly Plan assessment to the Fund.
D. Any failure by a hospital to pay the required Plan assessment shall be monitored by the Board, or its designee, and reported to the Commission.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.08 - Investment of Fund Assets

Current through Register Vol. 51, No. 14, July 12, 2024
The assets of the Fund shall be invested in the State Treasurer's interest allocation program, which shall provide interest to the Fund at the rate the State's General Fund earns interest on its investments.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.09 - Determination of Plan Benefits and Plan Structure

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall establish at least two standard benefit packages to be offered by the Plan.
B. The Board may choose to establish the standard benefit packages with the only difference between each standard benefit package being in the area of the cost-sharing requirements.
C. The standard benefit packages established by the Board shall be described in the contract between the Plan administrator and the Board and shall include:
(1) A list of covered benefits;
(2) A list of exclusions and limitations; and
(3) A description of the cost-sharing arrangements, including any deductibles, copayments, coinsurance, and annual or lifetime maximums.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.10 - Determination of Plan Premium

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall establish a premium rate for each standard benefit package in the Plan.
B. The Board may contract with an actuary to establish the premium rate for each standard benefit package in the Plan.
C. Standard Risk Rate.
(1) The Board shall establish a standard risk rate premium rate for each standard benefit package in the Plan.
(2) The standard risk rate for each standard benefit package in the Plan shall be developed by considering the premium rates charged by carriers in the State for coverage comparable to that of the standard benefit package.
(3) The Board may contract with an actuary to establish each standard risk rate.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.10-1 - Low-Income Subsidy

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:
(1) Is enrolled, or eligible to enroll, in the Plan;
(2) Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;
(3) Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and
(4) Provides to the plan administrator verification of annual household income in a form acceptable to the Board.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.11 - Evaluation of Plan

Current through Register Vol. 51, No. 14, July 12, 2024
The Board shall annually evaluate the Plan to assure that Plan enrollment does not exceed the number of members the Plan has the financial capacity to insure.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.12 - Marketing of Plan

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board shall establish and maintain public awareness of the Plan, including its eligibility requirements and enrollment procedures.
B. The methods to be used by the Board to establish and maintain public awareness of the Plan shall include, but are not limited to:
(1) Establishing a mailing list of interested persons, advocacy groups, carriers, and potential applicants to the Plan for the purpose of notifying them of the availability of coverage under the Plan;
(2) Releasing periodic press releases and articles that provide status reports on the operation of the Plan and information and instructions to eligible individuals who might be interested in applying for coverage under the Plan;
(3) Speaking to interested health insurance industry and public groups regarding the Plan;
(4) Distributing a brochure to interested persons through the Plan administrator that describes the coverage available through the Plan and the process by which an individual may apply for coverage under the Plan;
(5) Publishing an annual report to the General Assembly, participants, and other interested persons regarding the status of the Plan, its mission, and general eligibility information;
(6) Familiarizing insurance producers with the coverage available through the Plan and the process by which they may assist individuals in applying for coverage under the Plan; and
(7) Other mechanisms and activities the Board determines would be effective and appropriate.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.13 - Certificates of Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Plan administrator shall issue certificates of coverage to individuals covered under the Plan that describe the essential features of the Plan including:
(1) Benefits;
(2) Exclusions and limitations;
(3) Cost-sharing requirements;
(4) Any annual or lifetime maximums;
(5) Termination provisions; and
(6) Any utilization review or precertification requirements.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.14 - Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in §§D-F of this regulation, an individual is eligible for coverage under the Plan if the individual is:
(1) A medically uninsurable individual; and
(2) Satisfies any applicable residency requirement in §C of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.15 - Plan Enrollment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board or the Plan administrator, acting on behalf of the Board, shall accept and process applications from individuals for enrollment in the Plan.
B. Except as provided in §C of this regulation, an individual may apply for coverage under the Plan throughout each year.
C. If an individual's eligibility is based on the individual's prior denial of coverage by a carrier, the individual may only apply for Plan coverage within 6 months of the receipt of the prior denial.
D. An individual who enrolls in one standard benefit package may change coverage to another standard benefit package under the Plan only during the time periods specified in the individual's certificate of coverage.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 17 - MARYLAND HEALTH INSURANCE PLAN › Chapter 31.17.03 - Operation and Administration of the Plan › Section 31.17.03.16 - Preexisting Condition Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board may implement a preexisting condition exclusion for the Plan, which shall be described in the Board's contract with the Plan administrator.
B. If the Board implements a preexisting condition exclusion for the Plan, the preexisting condition exclusion may not apply to:
(1) An eligible individual under the Maryland Health Insurance Portability and Accountability Act as defined in Insurance Article, §
										15-1301, Annotated Code of Maryland, if the individual applies for the Plan coverage within 63 days of losing prior coverage;
(2) A newborn child, provided that if an additional premium is required for the child's coverage, the child is enrolled within 31 days after the date of birth;
(3) A newly adopted child, provided that if an additional premium is required for the child's coverage, the child is enrolled within 31 days after the date of adoption; or
(4) An individual who:
(a) Has 3 months of prior creditable coverage;
(b) Is eligible for the tax credit for health insurance costs under §35 of the Internal Revenue Code; and
(c) Applies for the Plan coverage within 63 days after losing prior creditable coverage.