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31.11.10.00.htm 31.11.10.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 11 HEALTH INSURANCE ― GROUP Chapter 10 Required Standard Provisions Authority: Insurance Article, ァ12-203(g) Annotated Code of Maryland
31.11.10.01.htm 31.11.10.01. 01 Scope.. This chapter applies to each group health insurance contract, each blanket health insurance contract, and each group nonprofit health service plan contract issued or delivered in Maryland.
31.11.10.02.htm 31.11.10.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Blanket health insurance" has the meaning stated in Insurance Article, §15-305, Annotated Code of Maryland.2) "Carrier" means an insurer or nonprofit health service plan.. 2-1) “Coverage period” means the interval of time the blanket health insurance contract or group health insurance contract provides protection, in exchange for the payment of a particular premium.
31.11.10.03.htm 31.11.10.03. 03 Required Standard Provisions.. A. A group health insurance contract may not be delivered in Maryland unless it contains in substance the provisions:1) Listed in Regulation .04 of this chapter; or. 2) Which in the opinion of the Commissioner, as compared to the provisions in Regulation .04 of this chapter, are:a) More favorable to the individuals insured, or. b) At least as favorable to the individuals insured and more favorable to the policyholder.. B. A blanket health insur
31.11.10.04.htm 31.11.10.04. 04 Group Health Insurance Standard Provisions.. A. Entire Contract; Changes. Each group health insurance contract shall contain a provision that specifies:1) Which documents constitute the entire contract of insurance; and. 2) That a change in the policy may not be valid:. a) Until approved by an executive officer of the carrier, and. b) Unless the approval is endorsed on the policy or attached to the policy.. B. Contestability of Coverage..
31.11.10.05.htm 31.11.10.05. 05 Blanket Health Insurance Standard Provisions.. A. Each blanket health insurance contract shall contain in substance the provisions set forth in Regulation .04A, C, D, G, H, I, and L of this chapter.B. Statements in Applications. Each blanket health insurance contract shall contain a provision that:1) Absent fraud, each statement made by the group policyholder is considered to be a representation and not a warranty; and2) A statement made by the group policyholder may
31.11.10.06.htm 31.11.10.06. 06 Limitations and Exclusions.. A. Crime.. 1) Except as described in §A(3) of this regulation, a group health insurance contract or blanket health insurance contract may not include a limitation or exclusion for loss to which a contributing cause was the insured's commission of or attempt to commit a crime.2) A group health insurance contract or blanket health insurance contract may not include a limitation or exclusion for loss for which a contributing cause was the commission
31.11.10.07.htm 31.11.10.07. 07 Optional Provisions.. A. Physical Examination.. 1) A carrier may include a provision in a group health insurance contract or blanket health insurance contract giving the carrier the right to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim under the contract.2) If the carrier includes the provision described in §A(1) of this regulation, the provision shall indicate that any physical examination required by
31.11.10.9999.htm 31.11.10.9999. Administrative History Effective date: October 30, 2000 (27:21 Md. R. 1978). Regulation .02B amended effective October 18, 2010 (37:21 Md. R. 1438). Regulation .04N adopted effective October 18, 2010 (37:21 Md. R. 1438). Regulation .06A amended as an emergency provision effective May 9, 2003 (30:11 Md. R. 733) amended permanently effective October 27, 2003 (30:21 Md. R. 1531)
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