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31.12.02.00.htm 31.12.02.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 12 HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS Chapter 02 Health Maintenance Organizations ― Contract Forms and Premium Rates Authority: Health-General Article, Title 19, Subtitle 7; Insurance Article, §2-109 and 15-122; Annotated Code of Maryland
31.12.02.01.htm 31.12.02.01. 01 Authority and Purpose.. The Insurance Commissioner promulgates this chapter pursuant to Health-General Article, Title 19, Subtitle 7, Annotated Code of Maryland, for the purpose of governing and regulating various phases of the operations of health maintenance organizations.
31.12.02.02.htm 31.12.02.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Advertising" means:. a) Printed and published material;. b) Descriptive literature and sales aids;. c) Sales talks;. d) Sales materials, booklets, forms, pamphlets, brochures, illustrations, depictions, and form letters;e) Newspaper, radio, television, or direct mail advertising; and. f) Any other material used for the promotion of enrollment.. 2) "Carrier" means:.
31.12.02.03.htm 31.12.02.03. 03 Submittals.. A. Submittals of Forms to Commissioner.. 1) An HMO shall submit to the Commissioner for approval every form that it intends to use in Maryland.2) The Commissioner shall either approve or disapprove the form for use within 60 days of the receipt of the form in the Commissioner's office.3) An HMO may not use a form before the Commissioner's approval unless the Commissioner has not acted at the end of the 60-day period described in §A(2) of this regulation.
31.12.02.04.htm 31.12.02.04. 04 Variable Information.. A. Individual Contracts.. 1) Except as specified in §A(2) of this regulation, an HMO may not include variable material in an individual contract, or in a form to be used with an individual contract.2) An HMO may include variable material, in an individual contract or in a form to be used with an individual contract in the following portions of the form:a) The specifications, data, or schedule page;. b) The product marketing name;.
31.12.02.05.htm 31.12.02.05. 05 Failure to Respond to the Commissioner's Correspondence.. A. The Commissioner shall deem a filing withdrawn by the HMO if the HMO fails to respond to correspondence from the Commissioner regarding the filing within 90 days of the date of the correspondence from the Commissioner.B. If an HMO resubmits a form for approval after 90 days of the date of the Commissioner's correspondence regarding the filing in which the form was included, the HMO shall:
31.12.02.06.htm 31.12.02.06. 06 Contract Forms.. A. Form Numbers.. 1) Each form shall be identified by a form number that is unique to that form.. 2) The form number shall be printed in the lower left corner of the first page, and no other number may appear near the form number.B. The text of each form shall be printed in a style of type which is easily legible, the size of which shall be uniform and not less than 10 point with a lower case unspaced alphabet length not less than 120 point. The text
31.12.02.07.htm 31.12.02.07. 07 Application.. A. An application form shall stipulate the plan and any optional benefits being applied for.. B. Permissible Look-Back Periods.. 1) Except as provided in §B(2) of this regulation, an application form may not ask any question relative to any previously existing injury, sickness, or condition which has not required medical care or advice during the:a) 7-year period immediately preceding the date of the application if the application is made for co
31.12.02.08.htm 31.12.02.08. 08 Charges.. A. The submittal of a form shall be accompanied by the submittal of the rates charged for it, together with detailed supporting actuarial data. Subsequent changes in charged rates shall be submitted with detailed supporting actuarial data at least 60 days before the date that any change in the rate is proposed to become effective.B. The Commissioner shall approve or disapprove any rate submittal or change in the same manner as prescribed for approval or
31.12.02.09.htm 31.12.02.09. 09 Advertising.. A. Advertising shall be truthful and may not be misleading in fact or implication.. B. Advertising may not use words or phrases whose:. 1) Meaning is unclear or ambiguous; or. 2) Understanding depends upon familiarity with technical terminology.. C. Advertising may not include words, phrases, or illustrations that are used in a manner which misleads or has the capacity or tendency to deceive or mislead.
31.12.02.10.htm 31.12.02.10. 10 Termination of Services.. A. Termination of a Particular Service.. 1) If an HMO desires to cease offering a service under the health care contract in force, the services may not be terminated without prior approval of the Commissioner.2) If an HMO ceases offering a service under an in-force health care contract, arrangements equitable to the members regarding a cost adjustment or substitution of an equivalent service satisfactory to the Commissioner shall be made.
31.12.02.11.htm 31.12.02.11. 11 Conversion of Coverage ― Repealed.
31.12.02.12.htm 31.12.02.12. 12 General Operation of Health Maintenance Organizations.. A. The HMO shall provide, without limitations as to frequency or cost, except as established in the health care contract and provided for in these regulations, basic and supplemental health services to its members in the following manner:1) Reasonable deductibles and copayments may be required for the provision of specific services within the basic health services, unless the payments or the manner of payment
31.12.02.13.htm 31.12.02.13. 13 Provider Contracts.. A. All signed written agreements, including those defining physicians' services, shall be on file and available for review by the Commissioner at all times in the HMO's central office.B. If agreements with consultants or other institutions are established by any HMO, the responsibilities, functions, objectives, and the terms of the agreements including financial arrangements and charges, of each outside resource shall be described in writing and signed by
31.12.02.9999.htm 31.12.02.9999. Administrative History Effective date: October 1, 1977 (4:18 Md. R. 1426). Regulation .01 amended effective April 1, 1991 (18:6 Md. R. 684). Regulation .02 amended effective April 1, 1991 (18:6 Md. R. 684). Regulation .04 amended effective April 1, 1991 (18:6 Md. R. 684) ―. Chapter recodified from COMAR 09.30.55 to COMAR 31.12.02, July 1998. Regulation .04H amended effective January 9, 2000 (26:27 Md. R. 2018) ―. Chapter revised effective October 10, 2005 (32:10 Md. R. 1657).
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