Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.07 - Required Standard Provisions
Section 31.12.07.03 - Required Standard Provisions
Universal Citation: MD Code Reg 31.12.07.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. A group 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 members, or
(b) At least as favorable to the members and more favorable to the group contract holder.
B. An individual contract may not be delivered in Maryland unless it contains in substance the provisions:
(1) Listed in Regulation .05 of this chapter; or
(2) Which in the opinion of the Commissioner, as compared to the provisions in Regulation .05 of this chapter, are at least as favorable to the subscriber and members.
C. Inapplicable and Inconsistent Provisions. If a provision required by Regulation .04 or .05 of this chapter is wholly or partly inapplicable to or inconsistent with the coverage provided by a particular contract, the HMO shall:
(1) Omit from the contract the inapplicable provision or part of the provision; or
(2) Modify the inconsistent provision or part of the provision to make it consistent with the coverage provided by the contract.
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