Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.02 - Health Maintenance Organizations - Contract Forms and Premium Rates
Section 31.12.02.04 - Variable Information
Universal Citation: MD Code Reg 31.12.02.04
Current through Register Vol. 51, No. 19, September 20, 2024
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;
(c) The address of the HMO;
(d) Signatures of officers of the HMO;
(e) Descriptions of copayment amounts, deductibles, coinsurance amounts, out-of-pocket limits, annual maximums, or lifetime maximums;
(f) Specific dates, such as effective dates and termination dates; and
(g) Descriptions of benefit amounts or benefit limits.
(3) If an individual contract or a form to be used with an individual contract contains variable material as permitted under §A(2) of this regulation, the HMO shall:
(a) Bracket the variable material or otherwise mark the variable material to denote variability; and
(b) Include a statement of variability, in duplicate, that discusses how each variable item may change.
(4) If an individual contract or a form to be used with an individual contract is approved with variable material, an HMO may not submit a new statement of variability to be used with the previously approved contract or form, except for the following:
(a) Copayment amounts;
(b) Coinsurance amounts;
(c) Deductible amounts;
(d) Out-of-pocket limits;
(e) Annual maximums;
(f) Lifetime maximums;
(g) Benefit amounts; or
(h) Benefit limits.
(5) An HMO shall include the following with a new statement of variability filing for a previously approved form:
(a) A cover letter identifying the HMO and the HMO's National Association of Insurance Commissioners company code number; and
(b) The form number and date of approval of the form for which new variable material is being submitted.
B. Group Contracts.
(1) An HMO may include variable material in a group contract or in a form to be used with a group contract, if the HMO:
(a) Brackets the variable material or otherwise marks the variable material to denote variability; and
(b) Includes a statement of variability, in duplicate, that discusses how each variable item may change, including all textual variations that are intended.
(2) If a group contract or a form to be used with a group contract is approved with variable material, an HMO may not submit a new statement of variability to be used with the previously approved group contract or form, except for the following:
(a) Copayment amounts;
(b) Coinsurance amounts;
(c) Deductible amounts;
(d) Out-of-pocket limits;
(e) Annual maximums;
(f) Lifetime maximums;
(g) Benefit amounts; or
(h) Benefit limits.
(3) An HMO shall include the following with a new statement of variability filing for a previously approved form:
(a) A cover letter identifying the HMO and the HMO's National Association of Insurance Commissioners company code number; and
(b) The form number and date of approval of the form for which new variable material is being submitted.
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