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31.10.25.00.htm 31.10.25.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 25 Required Standard Provisions for Individual Nonprofit Health Service Plan Contracts Authority: Insurance Article, §12-203(g) Annotated Code of Maryland
31.10.25.01.htm 31.10.25.01. 01 Scope.. This chapter applies to each individual nonprofit health service plan contract issued or delivered in Maryland.
31.10.25.02.htm 31.10.25.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Carrier" means a nonprofit health service plan.. 2) "Covered individual" means an individual covered under an individual contract.. 2-1) “Coverage period” means the interval of time the individual contract provides protection to the insured, in exchange for the payment of a particular premium.2-2) “Health benefit plan” has the meaning stated in Insurance Article, §15
31.10.25.03.htm 31.10.25.03. 03 Required Standard Provisions.. A. An individual contract may not be delivered in Maryland unless it contains in substance the provisions listed in Regulation .04 of this chapter, or provisions which in the opinion of the Commissioner are not less favorable in any respect to the subscriber and covered individuals.B. Inapplicable and Inconsistent Provisions. If a provision required by Regulation .04 of this chapter is wholly or partly inapplicable to or inconsis
31.10.25.04.htm 31.10.25.04. 04 Standard Provisions.. A. Entire Contract; Changes. Each individual contract shall contain in substance the following provision: "Entire contract; changes: This certificate, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this certificate shall be valid until approved by an executive officer of the carrier and unless such approval is endorsed on the certificate or attached to the certificate. No age
31.10.25.05.htm 31.10.25.05. 05 Limitations and Exclusions.. A. Crime.. 1) An individual contract may not include a limitation or exclusion for loss to which a contributing cause was the covered individual's commission of or attempt to commit a crime.2) An individual contract may not include a limitation or exclusion for loss for which a contributing cause was the commission of or the attempt to commit a crime by an individual other than the covered individual.B. Illegal Occupation. An individual contract may
31.10.25.06.htm 31.10.25.06. 06 Optional Provisions.. A. A carrier may include any of the optional provisions described in §C―G of this regulation.. B. A carrier may not include an optional provision dealing with the same subjects set forth in §C―G of this regulation if the provision is drafted in a manner that is less favorable to the subscriber or any covered individual than the corresponding optional provision set forth in §C―G of this regulation.C. Physical Examination.. 1) A carrier may include
31.10.25.9999.htm 31.10.25.9999. Administrative History Effective date: October 30, 2000 (27:21 Md. R. 1978). Regulation .02B amended effective October 18, 2010 (37:21 Md. R. 1438) May 9, 2016 (43:9 Md. R. 532). Regulation .04C amended effective November 7, 2005 (32:22 Md. R. 1760). Regulation .04C, D amended effective May 9, 2016 (43:9 Md. R. 532). Regulation .04M adopted effective October 18, 2010 (37:21 Md. R. 1438). Regulation .04M amended effective April 22, 2019 (46:8 Md. R. 402). Regulation .05A amended a
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