reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.13 - Military Sales Practices › Section 31.09.13.05 - Exemptions

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter does not apply to solicitations or sales involving:
(1) Credit insurance;
(2) Group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not include a side fund;
(3) An application to the existing insurer that issued the existing policy or contract when:
(a) A contractual change or a conversion privilege is being exercised;
(b) The existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner; or
(c) A term conversion privilege is exercised among corporate affiliates;
(4) Individual health policies, including disability income policies;
(5) Contracts offered by Service members' Group Life Insurance (SGLI) or Veterans' Group Life Insurance (VGLI), as authorized by 38 U.S.C. §
											1965 et seq. (2007);
(6) Life insurance contracts offered through or by a nonprofit military association, qualifying under 26 U.S.C. §
											501(c)(23) (2007), and which are not underwritten by an insurer; or
(7) Contracts used to fund:
(a) An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);
(b) A plan described by §401(a), 401(k), 403(b), 408(k), or 408(p) of the Internal Revenue Code, as amended, if established or maintained by an employer;
(c) A government or church plan defined in §414 of the Internal Revenue Code, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under §457 of the Internal Revenue Code;
(d) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;
(e) Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or
(f) Prearranged funeral contracts.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.13 - Military Sales Practices › Section 31.09.13.06 - Practices Declared False, Misleading, Deceptive, or Unfair on a Military Installation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following acts or practices when committed on a military installation by an insurer or insurance producer with respect to the in-person, face-to-face solicitation of life insurance or annuity are prohibited as false, misleading, deceptive, or unfair:
(1) Knowingly soliciting the purchase of any life insurance product or annuity door-to-door or without first establishing a specific appointment for each meeting with the prospective purchaser;
(2) Soliciting service members in a group or mass audience or in a captive audience where attendance is not voluntary;
(3) Knowingly making appointments with or soliciting service members during their normally scheduled duty hours;
(4) Making appointments with or soliciting service members in barracks, day rooms, unit areas, transient personnel housing, or other areas where the installation commander has prohibited solicitation;
(5) Soliciting the sale of life insurance or annuity without first obtaining permission from the installation commander or the commander's designee;
(6) Posting unauthorized bulletins, notices, or advertisements;
(7) Failing to present DD Form 2885, Personal Commercial Solicitation Evaluation, to service members solicited or encouraging service members solicited not to complete or submit a DD Form 2885, as set forth in §C of this regulation; and
(8) Knowingly accepting an application or issuing a policy for life insurance or annuity, on the life of an enlisted member of the United States Armed Forces without first obtaining for the insurer's files a completed copy of any required form which confirms that the applicant has received counseling or fulfilled any other similar requirement for the sale of life insurance established by regulations, directives, or rules of the DoD or any branch of the Armed Forces.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.13 - Military Sales Practices › Section 31.09.13.07 - Practices Declared False, Misleading, Deceptive, or Unfair Regardless of Location

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following acts or practices by an insurer or insurance producer constitute corrupt practices, improper influences, or inducements, regardless of location, and therefore, are prohibited as false, misleading, deceptive, or unfair:
(1) Submitting, processing, or assisting in the submission or processing of any allotment form or similar device used by the United States Armed Forces to direct a service member's pay to a third party for the purchase of life insurance or annuity, which acts include but are not limited to:
(a) Using or assisting in using a service member's "MyPay" account; or
(b) Using another similar internet or electronic medium for such purposes.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.13 - Military Sales Practices › Section 31.09.13.08 - Severability

Current through Register Vol. 51, No. 14, July 12, 2024
If any provision of this chapter or the application thereof to any person or circumstance is held invalid for any reason, the invalidity does not affect the other provisions or any other application of these sections which can be given effect without the invalid provisions or application. To this end all provisions of this chapter are declared to be severable.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.13 - Military Sales Practices › Section 31.09.13.09 - Effective Date

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter is effective May 1, 2008, and shall apply to acts or practices committed on or after the effective date.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to establish standards for universal life insurance policies in order to accommodate the development and issuance of universal life insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.03 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. As used in this chapter, the following terms have the meanings indicted.
B. Terms Defined.
(1) "Cash surrender value" means the net cash surrender value plus any amounts outstanding as policy loans.
(2) "Commissioner" means the Maryland Insurance Commissioner.
(3) "Fixed premium universal life insurance policy" means a universal life insurance policy other than a flexible premium universal life insurance policy.
(4) "Flexible premium universal life insurance policy" means a universal life insurance policy which permits the policyowner to vary, independently of each other, the amount or timing of one or more premium payments or the amount of insurance.
(5) "Interest-indexed universal life insurance policy" or "interest-indexed policy" means any universal life insurance policy where the interest credits are linked to an external referent.
(6) "Net cash surrender value" means the maximum amount payable to the policyowner upon surrender.
(7) "Policy value" means the amount to which separately identified interest credits and mortality, expense, or other charges are made under a universal life insurance policy.
(8) "Universal life insurance policy" means a life insurance policy where separately identified:
(a) Interest credits, other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts are made to the policy;
(b) Mortality charges are made to the policy; and
(c) Expense charges are made to the policy.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.04 - General Calculation Method for Reserves

Current through Register Vol. 51, No. 14, July 12, 2024
A. The minimum valuation standard for universal life insurance policies shall be
(1) The Commissioner's Reserve Valuation Method, as described in §B of this regulation for such policies; and
(2) The mortality tables and interest rates specified in §B(2) of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.05 - Alternative Minimum Reserves

Current through Register Vol. 51, No. 14, July 12, 2024
A. If, in any policy year, the guaranteed maturity premium on a universal life insurance policy is less than the valuation net premium for the same universal life insurance policy, calculated by the valuation method actually used in calculating the reserve on the universal life insurance policy, but using the minimum valuation standards of mortality and rate of interest, the minimum reserve required for the universal life insurance policy shall be the greater of:
(1) The reserve calculated according to the method, the mortality table, and the rate of interest actually used; and
(2) The reserve calculated according to the method actually used but using the minimum valuation standards of mortality and rate of interest and replacing the valuation net premium by the Guaranteed Maturity Premium in each policy year for which the valuation net premium exceeds the Guaranteed Maturity Premium.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.06 - Nonforfeiture Values for Flexible Premium Universal Life Insurance Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. Minimum cash surrender values for flexible premium universal life insurance policies shall be determined separately for the basic policy and for any benefits and riders for which premiums are paid separately.
B. The requirements in this regulation pertain to a basic policy and any benefits and riders for which premiums are not paid separately.
C. The minimum cash surrender value, before adjustment for indebtedness and dividend credits, available on a date as of which interest is credited to the policy shall be equal to:
(1) The accumulation to that date of the premiums paid; minus
(2) The accumulations to that date of:
(a) The benefit charges;
(b) The averaged administrative expense charges for the first policy year and any insurance-increase years;
(c) Actual administrative expense charges for other years;
(d) Initial and additional acquisition expense charges not exceeding the initial or additional expense allowances, respectively;
(e) Any service charges actually made, excluding charges for cash surrender or election of a paid-up nonforfeiture benefit; and
(f) Any deductions made for partial withdrawals; minus
(3) Any unamortized unused initial and additional expense allowances.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.07 - Nonforfeiture Values for Fixed Premium Universal Life Insurance Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. For fixed premium universal life insurance policies, the minimum cash surrender values shall be determined separately for the basic policy and any benefits and riders for which premiums are paid separately.
B. The requirements in this regulation pertain to a basic policy and to any benefits and riders for which premiums are not paid separately.
C. The minimum cash surrender value, before adjustment for indebtedness and dividend credits, available on a date as of which interest is credited to the policy shall be equal to [(A)-(B)-(C)-(D)], where:
(1) The quantity (A) is the present value of all future guaranteed benefits;
(2) The quantity (B) is the present value of future adjusted premiums;
(3) The quantity (C) is the present value of any quantities analogous to the nonforfeiture net level premium which arise because of guarantees declared by the insurer after the issue date of the policy; and
(4) The quantity (D) is the sum of any quantities analogous to (B), as described in §C(2) of this regulation, which arise because of structural changes in the policy.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.08 - Minimum Paid-Up Nonforfeiture Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
A. If a universal life insurance policy provides for the optional election of a paid-up nonforfeiture benefit, it shall be such that its present value shall be at least equal to the cash surrender value provided for by the policy on the effective date of the election.
B. The present value in §A of this regulation shall be based on mortality and interest standards at least as favorable to the policyowner as:
(1) In the case of a flexible premium universal life insurance policy, the mortality and interest basis guaranteed in the policy for determining the policy value; or
(2) In the case of a fixed premium policy the mortality and interest standards permitted for paid-up nonforfeiture benefits by Insurance Article, §§
										16-306 and  16-309(i), Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.09 - Mandatory Policy Provisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In addition to the applicable provisions of Insurance Article, Title 16, Annotated Code of Maryland, each universal life insurance policy shall include the provisions described in §§B-H of this regulation.
B. Periodic Disclosure to Policyowner.
(1) The policy shall provide that the policyowner will be sent, without charge, at least annually, a report that satisfies the requirements of Regulation .11 of this chapter, which will serve to keep the policyowner advised as to the status of the policy.
(2) The end of the current report period shall be not more than 3 months before the date of the mailing of the report.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.10 - Disclosure Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
Disclosure of information about the policy being applied for shall follow the standards in COMAR 31.09.09.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.11 - Periodic Disclosure to Policyowner

Current through Register Vol. 51, No. 14, July 12, 2024
A. Annual Report.
(1) The policy shall provide that the policyowner will be sent, without charge, at least annually, a report which will serve to keep the policyowner advised of the status of the policy.
(2) The end of the current report period shall be not more than 3 months before the date of the mailing of the report.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.12 - Interest-Indexed Universal Life Insurance Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. Initial Filing Requirements.
(1) The following information shall be submitted in connection with any filing of interest-indexed universal life insurance policies:
(a) A description of how the interest credits are determined, including:
(i) A description of the index;
(ii) The relationship between the value of the index and the actual interest rate to be credited;
(iii) The frequency and timing of determining the interest rate; and
(iv) The allocation of interest credits, if more than one rate of interest applies to different portions of the policy value;
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.15 - Universal Life Insurance › Section 31.09.15.13 - Sample Statement of Actuarial Opinion

Current through Register Vol. 51, No. 14, July 12, 2024
The following form is a sample form that may be used for providing the statement of actuarial opinion as described in Regulation .12 of this chapter:
I, {insert name of actuary}, am {insert position or relationship to Insurer} for the XYZ Life Insurance Company (The Insurer) in the state of {Insert State of Domicile of Insurer}. I am a member of the American Academy of Actuaries (or if not, state other qualifications to sign annual statement actuarial opinions). I have examined the interest-indexed universal life insurance policies of the Insurer in force as of December 31, 20XX, encompassing _______ number of policies and $__________ of insurance in force. I have considered the provisions of the policies. I have considered any reinsurance agreements pertaining to such policies, the characteristics of the identified assets, and the investment policy adopted by the Insurer as they affect future insurance and investment cash flows under such policies and related assets. My examination included such tests and calculations as I considered necessary to form an opinion concerning the insurance and investment cash flows arising from the policies and related assets. I relied on the investment policy of the Insurer and on projected investment cash flows as provided by __________________________, Chief Investment Officer of the Insurer. The tests were conducted under various assumptions as to future interest rates, and particular attention was given to those provisions and characteristics that might cause future insurance and investment cash flows to vary with changes in the level of prevailing interest rates. In my opinion, the anticipated insurance and investment cash flows referred to above make good and sufficient provision for the contractual obligations of the Insurer under these insurance policies. __________________________ Signature of Actuary"
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to regulate accelerated benefit provisions in individual and group life insurance policies and to provide required standards of disclosure.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.02 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall apply to all accelerated benefit provisions of individual and group life insurance policies issued or delivered in Maryland except those subject to Insurance Article, Title 18, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.03 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicted.
B. Terms Defined.
(1) 'Accelerated benefits " means benefits payable under a life insurance contract that:
(a) Are payable during the lifetime of the insured in anticipation of death or upon the occurrence of specified life-threatening or catastrophic conditions as defined by the policy or rider, to a policy owner or certificate holder;
(b) Reduce the death benefit otherwise payable under the life insurance contract; and
(c) Are payable upon the occurrence of a single qualifying event that results in the payment of a benefit amount fixed at the time of acceleration.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.04 - Type of Product

Current through Register Vol. 51, No. 14, July 12, 2024
A. Accelerated benefit riders and life insurance policies with accelerated benefit provisions are primarily mortality risks rather than morbidity risks.
B. The inclusion of terminal illness as a qualifying event shall be included in all accelerated benefit policies and riders.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.05 - Assignee or Irrevocable Beneficiary

Current through Register Vol. 51, No. 14, July 12, 2024
Prior to the payment of the accelerated benefit, the insurer shall obtain from an assignee or irrevocable beneficiary a signed acknowledgement of concurrence for payout. If the insurer is the assignee under the policy, no acknowledgement is required.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.06 - Criteria for Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Lump Sum Settlement Option.
(1) The insurer shall include the option to take the benefit as a lump sum in the contract payment options.
(2) The benefit may not be made available as an annuity contingent upon the life of the insured.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.07 - Disclosures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Descriptive Title.
(1) The insurer shall include the term "accelerated benefit" in the policy or rider's title.
(2) An accelerated benefit product being offered under this chapter may not be described or marketed as long-term care insurance or as providing long-term care benefits.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.08 - Effective Date of the Accelerated Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
A. The accelerated benefit provision shall be effective for accidents on the effective date of the policy or rider.
B. The accelerated benefit provision shall be effective for illness no more than 30 days following the effective date of the policy or rider.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.09 - Waiver of Premiums

Current through Register Vol. 51, No. 14, July 12, 2024
A. The insurer may offer a waiver of premium for the accelerated benefit provision in the absence of a waiver of premium provision for the policy being in effect.
B. At the time the benefit is claimed, the insurer shall explain to the policy holder or certificate holder any continuing premium requirements to keep the policy in force.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.10 - Discrimination

Current through Register Vol. 51, No. 14, July 12, 2024
An insurer may not:
A. Unfairly discriminate among insureds with differing qualifying events covered under the policy or among insureds with similar qualifying events covered under the policy;
B. Apply further conditions on the payment of the accelerated benefits other than those conditions specified in the policy or rider.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.11 - Actuarial Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A. Financing Options.
(1) The insurer may require a premium charge or cost of insurance charge for the accelerated benefit as follows:
(a) The insurer shall base the charge on sound actuarial principles; and
(b) For group insurance, the insurer may reflect the additional cost in experience rating.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 09 - LIFE INSURANCE AND ANNUITIES › Chapter 31.09.16 - Accelerated Benefits › Section 31.09.16.12 - Actuarial Disclosure and Reserves

Current through Register Vol. 51, No. 14, July 12, 2024
A. Actuarial Memorandum.
(1) A qualified actuary shall describe the accelerated benefits, the risks, the expected costs, and the calculation of statutory reserves in an actuarial memorandum accompanying each filing.
(2) The insurer shall maintain in its files descriptions of the bases and procedures used to calculate benefits payable under this chapter. The descriptions shall be made available for examination by the Commissioner upon request.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.01 - Health Insurance › Section 31.10.01.01 - Applicability

Current through Register Vol. 51, No. 14, July 12, 2024
Every health insurance policy issued under Insurance Article, Title 15, Annotated Code of Maryland, as amended to date, shall comply with this chapter (except that Regulation .03D and J of this chapter are not applicable to policies issued under Insurance Article, Title 13, Subtitle 3), as well as with any other regulations promulgated under Insurance Article, §
									12-203, concerning the submission of forms. As used in these regulations, the word "forms" includes applications, policies, certificates, contracts, riders, and endorsements except when the context indicates otherwise.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.01 - Health Insurance › Section 31.10.01.02 - 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) "Carrier" means a person that is:
(a) An insurer; or
(b) A nonprofit health service plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.02 - Health Insurance-Simplified Language › Section 31.10.02.01 - Applicability

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter does not apply to:
(1) Group health insurance policies initially issued to employer/employee groups of more than 1,000 employees;
(2) Group health insurance policies issued pursuant to a collective bargaining labor-management agreement; or
(3) Reinsurance contracts.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.02 - Health Insurance-Simplified Language › Section 31.10.02.02 - Minimum Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A. In addition to any other requirements or law, a policy form to which this chapter is applicable may not be issued or delivered in this State unless:
(1) The text achieves a minimum score of 40 on the Flesch Reading Ease Test;
(2) The policy contains a table of contents or an index of the principal sections of the policy if it has more than 3,000 words or more than three pages regardless of the number of words;
(3) The style, arrangement, and overall appearance of the policy do not give undue prominence to any portion of the text or to any endorsements or riders; and
(4) Except for specification pages, schedules, tables, and tables of contents, if any, the policy is plainly printed in a style in general use and the size is uniform and not less than 10-point type, 1-point leaded, with a lower case alphabet length not less than 120 point.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.02 - Health Insurance-Simplified Language › Section 31.10.02.03 - Flesch Reading Ease Test Scores

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Flesch Reading Ease Test scores shall be calculated according to the requirements of B-----F of this regulation.
B. For policy forms containing 10,000 words or less of text, the entire form shall be analyzed. For policy forms containing more than 10,000 words, the readability of two 200-word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least 20 printed lines.
C. The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015.
D. The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6.
E. The sum of the figures computed in C and D of this regulation, subtracted from 206.835, equals the Flesch Reading Ease Test Score for the policy form.
F. For purposes of C-----E of this regulation, the following procedures shall be used:
(1) A contraction, hyphenated word, or number or letter separated by spaces is counted as one word;
(2) A unit of words ending with a period, semicolon, or colon, but excluding headings and captions, is counted as one sentence; and
(3) A syllable means a unit of spoken language consisting of one or more letters of a word as divided by a commonly accepted dictionary, although when the dictionary shows two or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.02 - Health Insurance-Simplified Language › Section 31.10.02.04 - Certification

Current through Register Vol. 51, No. 14, July 12, 2024
A policy form to which these regulations apply, and which is required to be submitted for approval in accordance with Insurance Article, 12-203 and 12-205, Annotated Code of Maryland, shall be accompanied by a certificate signed by an officer of the insurer stating that the language of the form has been measured by the Flesch Reading Ease Test, and giving the resulting score achieved on that test. If any language has been omitted from the test in accordance with Regulation .03G(2) of this chapter, the certificate shall so specify.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.02 - Health Insurance-Simplified Language › Section 31.10.02.05 - Effective Date

Current through Register Vol. 51, No. 14, July 12, 2024
A. These regulations apply to all health insurance policies, certificates, riders, and endorsements submitted for approval on or after January 1, 1992.
B. If any policy form, certificate, rider, or endorsement which does not comply with the minimum standards of Regulation .02 of this chapter has been submitted for approval before January 1, 1992, and approved by the Commissioner, it may be issued or delivered in this State until January 1, 1997, but not after that unless it has been submitted or resubmitted in accordance with the requirements of these regulations. A policy form, certificate, rider, or endorsement submitted before January 1, 1992, which complies with the minimum standards of Regulation .02 of this chapter need not be resubmitted.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.04 - Health Insurance-Plan of Withdrawal › Section 31.10.04.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter applies to all insurers writing health insurance in this State.
B. This chapter does not apply to health benefit plans issued under Insurance Article, Title 15, Subtitles 12, 13, or 14, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.04 - Health Insurance-Plan of Withdrawal › Section 31.10.04.02 - 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) "Health benefit plan" has the meaning stated in Insurance Article, §
										31-101, Annotated Code of Maryland.
(2) "Health insurance product" means any:
(a) Group or individual health insurance policy or contract which covers a Maryland resident;
(b) Individual health insurance contract issued to a Maryland resident; or
(c) Rider to any group or individual health insurance contract issued to a Maryland resident.
(3) "Single case basis" means a contract which was approved by the Maryland Insurance Administration for issuance to only one contract holder in Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.04 - Health Insurance-Plan of Withdrawal › Section 31.10.04.03 - Required Filings

Current through Register Vol. 51, No. 14, July 12, 2024
A. When an insurer intends to cancel or not renew a health insurance product for all of the insurer's covered insureds in the State, the insurer shall file a plan of withdrawal with the Commissioner at least 90 days from the date of the proposed cancellation or nonrenewal.
B. When an insurer intends to cancel or not renew all of the insurer's health insurance products for all of its covered insureds in the State, the insurer shall file a plan of withdrawal with the Commissioner at least 180 days before the date of the proposed withdrawal.
C. A plan of withdrawal may not be required for nonrenewal of a contract which was approved for issuance on a single case basis.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies, to facilitate public understanding and comparison of these policies, to eliminate policy provisions which may be misleading or confusing in connection with the purchase of the policies or with the settlement of claims, and to provide for full disclosures in the sale of health insurance coverages to persons eligible for Medicare by reason of age.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.02 - Authority

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter is issued pursuant to the authority given the Insurance Commissioner under Insurance Article, §
									2-109 and TItle 15, Subtitle 9, and Health-General Article, 19-705 and 19-706, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.03 - Applicability and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
Except as otherwise specifically provided, this chapter applies to all:
A. Medicare supplement policies and subscriber contracts delivered or issued for delivery in this State before July 1, 1992; and
B. Certificates issued under group Medicare supplement policies or subscriber contracts if the certificates were delivered or issued for delivery in this State before July 1, 1992.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.04 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Whenever used in this chapter or in a Medicare supplement policy subject to these regulations, or in any advertisement soliciting a Medicare supplement policy, the following terms shall have the meanings indicated.
B. Terms Defined.
(1) "Applicant" means, in the case of:
(a) An individual Medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and
(b) A group Medicare supplement policy or subscriber contract, the proposed certificate holder.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.05 - Policy Definitions and Terms

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurance policy, subscriber contract, or certificate may not be advertised, marketed, solicited, or issued for delivery in this State as a Medicare supplement policy unless it contains definitions or terms which conform to the requirements of this regulation, or definitions which are more favorable to the insured person or certificate holder.
B. Terms To Be Defined in the Policy.
(1) Accident.
(a) "Accident", "accidental injury", or "accidental means" shall be defined to employ "result" language and may not include words which establish an accidental means test or use words such as "external, violent, and accidental means", "visible contusion or wound", or words of similar import, description, or characterization.
(b) The definition may not be more restrictive than the following: "Injury or injuries for which benefits are provided means accidental bodily injury sustained by the insured person which is the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance coverage is in force."
(c) The definition may additionally provide that injuries do not include injuries for which benefits are provided or available to the insured under any workers' compensation, occupational disease, employer's liability, or similar law, or to the extent permitted by law, to benefits provided or available under any motor vehicle no-fault plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.06 - Prohibited Policy Provisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Waivers may not be included in or attached to a Medicare supplement policy if the effect of the waivers is to exclude, limit, or reduce coverage or benefits for specifically named or described diseases or physical conditions.
B. A Medicare supplement policy or subscriber contract may not be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy or subscriber contract if the policy or contract limits or excludes coverage by type of illness, accident, treatment, or medical condition, except for the following, provided however, that if any of the following limitations or exclusions are contained in a Medicare supplement policy, the limitation or exclusion may not be more restrictive than that applicable to the Medicare program:
(1) Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or symptomatic complaints of the feet;
(2) Mental or emotional disorders, alcoholism, and drug addiction;
(3) Illness, treatment, or medical condition arising out of:
(a) War or act of war (whether declared or undeclared), participation in a felony, riot or insurrection, service in the armed forces or auxiliary units,
(b) Suicide while sane or insane, attempted suicide, or intentionally self-inflicted injury, or
(c) Aviation or air travel other than as a fare-paying passenger on a regularly scheduled airline or on a group-chartered plane;
(4) Cosmetic surgery, but this exclusion may not apply to reconstructive surgery when the surgery is incidental to or follows surgery resulting from trauma, infection, or diseases of the involved part;
(5) Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference and their effects, if the interference is the result of or related to distortion, misalignment or subluxation of, or in, the vertebral column;
(6) Treatment provided in a federal government hospital, benefits provided under Medicare or other governmental program (except Medicaid), any workers' compensation, employer's liability or occupational disease or similar law, or any motor vehicle no-fault or similar law;
(7) Services rendered by, and separately billed by, the employees of hospitals, laboratories, or other institutions;
(8) Services performed by a member of the covered person's immediate family, and services for which no charge is normally made in the absence of insurance;
(9) Dental care or treatment;
(10) Eyeglasses, hearing aids, and examination for their prescription or fitting;
(11) Rest cures, custodial care, transportation, and routine physical examinations;
(12) Territorial limitations outside the United States; and
(13) Coverage of any expense to the extent of any benefit available to the insured under Medicare.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.08 - Standards for Claims Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each insurer providing Medicare supplement policies or contracts shall comply with all provisions of § 4081 of the Omnibus Budget Reconciliation Act of 1987 ( P.L. 100-203), and with applicable rules and regulations issued under the Act by the Secretary of the federal Department of Health and Human Services. Some of the provisions of the Act require each insurer issuing Medicare supplement policies to:
(1) Agree to accept claims notices as claims for benefits under the policies;
(2) Agree to make payment determination based on the information provided in the notices;
(3) Provide notices to participating providers and suppliers and to the beneficiaries concerning the payment determinations;
(4) Provide payment directly to participating providers and suppliers;
(5) Provide Medicare beneficiaries with the name and address of Medicare contracting carriers to which notices should be sent; and
(6) Agree to pay usual fees.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.09 - Loss Ratio Standards

Current through Register Vol. 51, No. 14, July 12, 2024
As soon as practicable, but before the effective date of Medicare benefit changes, each insurer issuing or delivering Medicare supplement policies or subscriber contracts in this State shall file with the Commissioner, in accordance with applicable filing procedures:
A. Appropriate premium adjustments necessary to produce loss ratios as originally anticipated for the applicable policies or certificates. Supporting documents necessary to justify the proposed adjustments shall be included with the filing. The following apply:
(1) Each insurer subject to the Medicare Supplement Act of Insurance Article, Annotated Code of Maryland, issuing or delivering Medicare supplement policies or contracts to residents of this State, shall make those premium adjustments which are necessary to produce an expected loss ratio under the policies or contracts which will conform with the minimum loss ratio standards for Medicare supplement policies and which are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums for the Medicare supplement policies or contracts. Premium adjustments shall be calculated for the period beginning with Medicare benefit changes.
(2) Premium adjustments which would modify the loss ratio under the policies and contracts other than the adjustments described in this section may be made only on the renewal date or anniversary date of the policy or contract.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 10 - HEALTH INSURANCE-GENERAL › Chapter 31.10.05 - Minimum Standards for Medicare Supplement Policies › Section 31.10.05.10 - Filing Requirements for Out-of-State Group Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each insurer providing group Medicare supplement insurance benefits to a resident of this State under a group policy issued elsewhere shall file a copy of the master policy and any certificate used in this State in accordance with the filing requirements and procedures applicable to group Medicare supplement policies issued in this State.
B. If the out-of-State group policy is issued to an employer having a home office in the state in which the policy is issued, the filing required by §A of this regulation shall be made not later than 30 days after the effective date of the certificate issued to any employee resident in this State.