2013 Maryland Code
INSURANCE
§ 15-508 - Imposition of preexisting condition provisions [Effective until January 1, 2014]


MD Ins Code § 15-508 (2013) What's This?

§15-508.

(a) (1) In this section the following words have the meanings indicated.

(2) “Carrier” has the meaning stated in § 15-1301 of this title.

(3) “Enrollment date” has the meaning stated in § 15-1301 of this title.

(4) “Policy or certificate” means any group or blanket health insurance contract or policy that is issued or delivered in the State by an insurer or nonprofit health service plan that provides hospital, medical, or surgical benefits on an expense-incurred basis.

(5) “Preexisting condition provision” has the meaning stated in § 15-1301 of this title.

(6) “Late enrollee” has the meaning stated in § 15-1401 of this title.

(b) This section does not apply to a policy or certificate issued to an individual in accordance with Subtitle 13 of this title.

(c) Except as otherwise provided in subsection (d) of this section, a carrier may impose a preexisting condition provision only if it:

(1) relates to a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;

(2) extends for a period of not more than 12 months after the enrollment date or 18 months in the case of a late enrollee; and

(3) is reduced by the aggregate of the periods of creditable coverage, as defined in Subtitle 14 of this title.

(d) (1) Subject to paragraph (4) of this subsection, a carrier may not impose any preexisting condition provision on an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.

(2) Subject to paragraph (4) of this subsection, a carrier may not impose any preexisting condition provisions on a child who:

(i) is adopted or placed for adoption before attaining 18 years of age; and

(ii) as of the last day of the 30-day period beginning on the date of adoption or placement for adoption, is covered under creditable coverage.

(3) A carrier may not impose any preexisting condition provisions relating to pregnancy.

(4) Paragraphs (1) and (2) of this subsection do not apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.

§ 15-508 - Imposition of preexisting condition provisions [Effective January 1, 2014]

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Carrier" has the meaning stated in § 15-1301 of this title.

(3) "Enrollment date" has the meaning stated in § 15-1301 of this title.

(4) "Plan year" means a calendar year or other consecutive 12-month period during which a health benefit plan provides coverage for health benefits.

(5) "Policy or certificate" means any group or blanket health insurance contract or policy that is issued or delivered in the State by an insurer or nonprofit health service plan that provides hospital, medical, or surgical benefits on an expense-incurred basis.

(6) "Preexisting condition provision" has the meaning stated in § 15-1301 of this title.

(7) "Late enrollee" has the meaning stated in § 15-1401 of this title.

(b) Scope of section. --

(1) This section does not apply to a policy or certificate issued to an individual in accordance with Subtitle 13 of this title.

(2) This section applies to carriers for plan years that begin before January 1, 2014.

(c) In general. -- Except as otherwise provided in subsection (d) of this section, a carrier may impose a preexisting condition provision only if it:

(1) relates to a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;

(2) extends for a period of not more than 12 months after the enrollment date or 18 months in the case of a late enrollee; and

(3) is reduced by the aggregate of the periods of creditable coverage, as defined in Subtitle 14 of this title.

(d) Limitations. --

(1) Subject to paragraph (4) of this subsection, a carrier may not impose any preexisting condition provision on an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.

(2) Subject to paragraph (4) of this subsection, a carrier may not impose any preexisting condition provisions on a child who:

(i) is adopted or placed for adoption before attaining 18 years of age; and

(ii) as of the last day of the 30-day period beginning on the date of adoption or placement for adoption, is covered under creditable coverage.

(3) A carrier may not impose any preexisting condition provisions relating to pregnancy.

(4) Paragraphs (1) and (2) of this subsection do not apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.

§ 15-508 - 1. Exclusionary provisions [Effective until January 1, 2014]

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Carrier" means an insurer or a nonprofit health service plan.

(3) "Creditable coverage" has the meaning stated in § 15-1301 of this title.

(4) "Exclusionary rider" means an endorsement to an individual health benefit plan that excludes benefits for one or more named conditions that are discovered by a carrier during the underwriting process.

(5) "Health benefit plan" has the meaning stated in § 15-1301 of this title.

(6) "Individual health benefit plan" means a health benefit plan issued by a carrier that insures:

(i) only one individual; or

(ii) one individual and one or more family members of the individual.

(b) Exclusionary rider. -- A carrier may not attach an exclusionary rider to an individual health benefit plan unless the carrier obtains the prior written consent of the policyholder.

(c) Preexisting condition exclusion or limitation. -- Except as provided in subsection (d) of this section, a carrier may impose a preexisting condition exclusion or limitation on an individual for a condition that was not discovered during the underwriting process for an individual health benefit plan only if the exclusion or limitation:

(1) relates to a condition of the individual, regardless of its cause, for which medical advice, diagnosis, care, or treatment was recommended or received within the 12-month period immediately preceding the effective date of the individual's coverage;

(2) extends for a period of not more than 12 months after the effective date of the individual's coverage; and

(3) is reduced by the aggregate of any applicable periods of creditable coverage.

(d) Preexisting condition exclusion or limitation -- Exception. --

(1) Subject to paragraph (2) of this subsection, a carrier may not impose a preexisting condition exclusion or limitation on an individual who, as of the last day of the 30-day period beginning with the date of the individual's birth, is covered under any creditable coverage.

(2) The limitation on the imposition of a preexisting condition exclusion or limitation under paragraph (1) of this subsection does not apply after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.

§ 15-508 - 1. Exclusionary provisions [Effective January 1, 2014]

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "Carrier" means an insurer or a nonprofit health service plan.

(3) "Creditable coverage" has the meaning stated in § 15-1301 of this title.

(4) "Exclusionary rider" means an endorsement to an individual health benefit plan that excludes benefits for one or more named conditions that are discovered by a carrier during the underwriting process.

(5) "Health benefit plan" has the meaning stated in § 15-1301 of this title.

(6) "Individual health benefit plan" means a health benefit plan issued by a carrier that insures:

(i) only one individual; or

(ii) one individual and one or more family members of the individual.

(b) Scope of section. -- This section applies to individual health benefit plans that are issued or delivered in the State before January 1, 2014.

(c) Exclusionary rider. -- A carrier may not attach an exclusionary rider to an individual health benefit plan unless the carrier obtains the prior written consent of the policyholder.

(d) Preexisting condition exclusion or limitation. -- Except as provided in subsection (e) of this section, a carrier may impose a preexisting condition exclusion or limitation on an individual for a condition that was not discovered during the underwriting process for an individual health benefit plan only if the exclusion or limitation:

(1) relates to a condition of the individual, regardless of its cause, for which medical advice, diagnosis, care, or treatment was recommended or received within the 12-month period immediately preceding the effective date of the individual's coverage;

(2) extends for a period of not more than 12 months after the effective date of the individual's coverage; and

(3) is reduced by the aggregate of any applicable periods of creditable coverage.

(e) Preexisting condition exclusion or limitation -- Exception. --

(1) Subject to paragraph (2) of this subsection, a carrier may not impose a preexisting condition exclusion or limitation on an individual who, as of the last day of the 30-day period beginning with the date of the individual's birth, is covered under any creditable coverage.

(2) The limitation on the imposition of a preexisting condition exclusion or limitation under paragraph (1) of this subsection does not apply after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.

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