COMAR 31.04.17 · Chapter 17 Filing of Forms for Approval

Administrative History Effective date: June 1, 1967 Amended effective May 1, 1968 Regulations .01 and .02I amended effective September 23, 1985 (12:19 Md. R. 1848) Regulation .01 amended effective July 19, 1993 (20:14 Md. R. 1169) Regulation .02A -1 adopted effective July 19, 1993 (20:14 Md. R. 1169) —————— Chapter recodified from COMAR 09.30.45 to COMAR 31.04.17 effective September 7, 1998 (25:18 Md. R. 1439) —————— Chapter revised effective April 25, 2005 (32:8 Md. R. 743) Regulation .03M amended effective October 1, 2019 (46:17 Md. R. 727) Regulation .03O adopted effective June 20, 2016 (43:12 Md. R. 668) Regulation .13A amended effective October 3, 2011 (38:20 Md. R. 1205) Authority Insurance Article, §§ 2-109 , 8-433 (a), 12-203 (a)( 1 )(i) and (2) and (b), 13-110(a), 14-109(3)(iv), 14-110(a)(2)(iii)1, 14-126, 14-405(b)(8) and (9), 14-410(c), 15-904, and 16-504(e), Annotated Code of Maryland

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.01 Applicability. The submission of any form required to be filed under Insurance Article, §§ 8-433 (a), 12-203 , 13-110 (a), 14-109 ( 3 )(iv), 14-110 (a)( 2 )(iii), 14-126 , 14-405 (b)( 8 ) and (9), or 14-410(c), Annotated Code of Maryland as amended to date, shall be in compliance with the regulations in this chapter, except to the extent that a regulation or portion of a regulation is not applicable to a particular form.

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.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) "Carrier" means: (a) An insurer; (b) A nonprofit health service plan; (c) A dental plan organization; or (d) A fraternal benefit society. (2) "Commissioner" means the Maryland Insurance Commissioner. (3) Contract on an Insert Page Basis. (a) "Contract on an insert page basis" means a contract that is composed of insert pages, with each insert page being identified with a unique form number. (b) "Contract on an insert page basis" does not include a contract that contains an insert that is identified with a unique form number and is longer than one page. (4) Contract on a Sectional Basis. (a) "Contract on a sectional basis" means a contract that is composed of sections, with each section being identified with a unique form number. (b) "Contract on a sectional basis" includes a contract that contains sections that are only one page long. (5) "Form" means: (a) A policy; (b) A contract; (c) A certificate; (d) A rider; (e) An endorsement; or (f) An application. (6) "Guaranteed renewable contract" means a health insurance contract that: (a) Permits the insured to renew the contract by timely payment of premiums: (i) Until 65 years old or until eligibility for Medicare; or (ii) In the case of a contract issued after 60 years old, for at least 5 years from its date of issue; and (b) Does not permit the carrier to make any unilateral change in any provision of the contract during the guaranteed renewability period, except that the carrier may make changes in premium rates by class. (7) "Health insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (8) "Insured" means an individual covered under a form. (9) "Insurer" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (10) "Life insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (11) "Noncancellable contract" means a health insurance contract that: (a) Permits the insured to renew the contract by timely payment of premiums: (i) Until 65 years old or eligibility for Medicare; or (ii) In the case of a contract issued after 60 years old, for at least 5 years from its date of issue; (b) Does not permit the carrier to make any unilateral change in any provisions of the contract during the period the contract is in force; and (c) Does not permit the carrier to change the premium rate during the period the contract is in force. (12) "Policyholder" means the individual or entity to whom the contract is issued.

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.03 Filing of Forms for Approval. A. Duplicate Forms Required For Nonelectronic Form Submissions. (1) A carrier shall submit duplicate copies of each form the carrier intends to use in Maryland to the Commissioner for approval. (2) If the Commissioner approves the form submitted by or on behalf of the carrier, the Commissioner shall: (a) Retain one copy; and (b) Return to the carrier one copy, with an appropriate notation indicating approval. B. A carrier submitting forms for approval, or premiums for forms pending approval or previously approved, shall print or type in a conspicuous manner immediately below the name of the carrier on the letter of transmittal the carrier's National Association of Insurance Commissioners (NAIC) company code number. C. A carrier shall submit the following with each form filing: (1) A current transmittal form developed by: (a) The Maryland Insurance Administration; or (b) The National Association of Insurance Commissioners (NAIC); (2) A filing fee in accordance with Insurance Article, §2-112, Annotated Code of Maryland ; (3) Except for electronic form filings, a self-addressed stamped envelope; and (4) A cover letter listing the forms submitted for approval by form number, with a brief description of each form filed for approval. D. Each form shall be identified by a form number which is unique to that form. This number should be printed in the lower lefthand corner of the first page, and no other number should appear in close proximity to the form number. If any loose leaf or alternate pages are submitted in accordance with Insurance Article, §12-203(e), Annotated Code of Maryland , each page shall also be identified by a unique form number. E. Each form shall be printed in a size and style of type which is easily legible. F. If any portion of a form is in a language other than English, an English translation shall appear in the same form. G. Name of Carrier. (1) Each complete form, except riders or endorsements, shall bear on the face the corporate name and either: (a) The address (city and state) of the carrier; or (b) The address of the carrier's office that will administer the form. (2) The name of the carrier shall appear with more prominence on a form than the name of: (a) An affiliate; (b) A producer; (c) An underwriter; (d) A holding company; or (e) A third party administrator. H. Modifications or Revisions. (1) A carrier may modify or revise a form only through: (a) Some form of press plate, such as imprinting, multigraph, mimeograph, multilith, electronic printer, or rubber stamp; or (b) A computer generated revision. (2) A carrier may not modify or revise a form through handwritten or typed interlineations or deletions. I. Submission of Forms. (1) Except as provided in §I(2) of this regulation , a carrier shall submit forms for approval with the Commissioner. (2) A third party may submit a form for approval on behalf of a carrier, if the third party includes a written authorization from the carrier to make the form filing. J. Submission Details. If the submission is new, the carrier shall point out the unique features of the form. K. Representative Specimen Data. (1) Except for applications filed for approval, a carrier shall complete each form filed for approval with representative specimen data. (2) A carrier shall use the following specimen data for life insurance policies: (a) 35 years old for a policy issued at that age; and (b) The lowest age of issue for juvenile policy forms. L. Mortality Table or Interest Rate Changes in Life Insurance or Annuity Contracts. If no other change in the contract is being filed at the same time, a carrier may file a change in the nonforfeiture basis for a previously approved contract by filing: (1) Revised pages for any pages in the contract that are affected; and (2) A revised actuarial memorandum demonstrating compliance with minimum nonforfeiture and reserve requirements. M. Any individual or group policy, group certificate, policy amendment, rider, or endorsement form shall have affixed the signature of a responsible officer of the carrier as part of the form. N. In the case of a life insurance policy or certificate, the carrier shall furnish a mathematical outline showing, for the specimen age and a specimen duration, computation of the: (1) Net premium; (2) Adjusted premium; (3) Nonforfeiture factor, if different from the adjusted premium for the specimen age used; and (4) Nonforfeiture values. O. Except for an annuity contract that is listed as exempt under Insurance Article, §16-501, Annotated Code of Maryland , in the case of an annuity contract, the carrier shall furnish: (1) A mathematical outline showing computation of the minimum nonforfeiture amounts; and (2) A numerical demonstration that the minimum paid-up annuity, cash surrender, or death benefits available under the contract are not less than the minimum benefits required under Insurance Article, Title 16, Subtitle 5, Annotated Code of Maryland .

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.04 Variable Materials, Insert Pages, and Contracts Comprised of Sections. A. Variable Information. (1) Individual Contracts. (a) Except as specified in §A(1)(b) of this regulation , a carrier may not include variable material in an individual contract, or in a form to be used with an individual contract. (b) A carrier 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: (i) The specifications, data, or schedule page; (ii) The product marketing name; (iii) The address of the carrier; (iv) Signatures of officers of the carrier; (v) Descriptions of copayment amounts, deductibles, coinsurance amounts, out-of-pocket limits, annual maximums, or lifetime maximums; (vi) Specific dates, such as effective dates and termination dates; and (vii) Descriptions of benefit amounts, benefit limits, waiting periods or elimination periods. (c) If an individual contract or a form to be used with an individual contract contains variable material as permitted under §A(1)(b) of this regulation , the carrier shall: (i) Bracket the variable material or otherwise mark the variable material to denote variability; and (ii) Include a statement of variability, in duplicate, that discusses how each variable item may change. (d) After an individual contract or a form to be used with an individual contract is approved with variable material, a carrier may not submit a new statement of variability to be used with the previously approved individual contract or form, except for the following: (i) Copayment amounts; (ii) Coinsurance amounts; (iii) Deductible amounts; (iv) Out-of-pocket limits; (v) Annual maximums; (vi) Lifetime maximums; (vii) Benefit amounts; (viii) Benefit limits; (ix) Waiting periods; or (x) Elimination periods. (e) A carrier shall include the following with a new statement of variability filing for a previously approved individual contract or form: (i) A cover letter identifying the carrier and the carrier's National Association of Insurance Commissioners company code number; and (ii) The form number and date of approval of the form for which new variable material is being submitted. (2) Group Contracts. (a) A carrier may include variable material in a group contract or in a form to be used with a group contract, if the carrier: (i) Brackets the variable material or otherwise marks the variable material to denote variability; and (ii) Includes a statement of variability, in duplicate, that discusses how each variable item may change, including all textual variations that are intended. (b) After a group contract or a form to be used with a group contract is approved with variable material, a carrier may not submit a new statement of variability to be used with the previously approved group contract or form, except for the following: (i) Copayment amounts; (ii) Coinsurance amounts; (iii) Deductible amounts; (iv) Out-of-pocket limits; (v) Annual maximums; (vi) Lifetime maximums; (vii) Benefit amounts; (viii) Benefit limits; (ix) Waiting periods; or (x) Elimination periods. (c) A carrier shall include the following with a new statement of variability filing for a previously approved group contract or form: (i) A cover letter identifying the carrier and the carrier's National Association of Insurance Commissioners company code number; and (ii) The form number and date of approval of the form for which new variable material is being submitted. B. Contracts with Insert Pages. (1) A carrier may file for approval of a contract on an insert page basis, only if: (a) Each insert page is identified by a unique form number appearing in the lower left corner of the insert page; and (b) The carrier includes the following in the filing submission: (i) A description of how the various insert pages will be combined; (ii) A listing of the insert pages that can be substituted for other specific insert pages; and (iii) The filing fee required under Insurance Article, §2-112, Annotated Code of Maryland , for each insert page with a unique form number. (2) A carrier may not file for approval of insert pages for use with a previously approved contract, if the previously approved contract was not approved on an insert page basis. (3) If a carrier files for approval of insert pages for a previously approved contract, the submission shall: (a) Identify by form number and date of approval any insert pages that the new insert pages will replace; and (b) Include a copy of the currently approved contract, unless the Commissioner waives the requirement or determines that a copy is not necessary to review the submission. C. Contracts Comprised of Sections. (1) A carrier may file for approval of a contract on a sectional basis, only if: (a) Each section is identified by a unique form number appearing in the lower left corner of the first page of the section; and (b) The carrier includes the following in the filing submission: (i) A description of how the various sections will be combined; (ii) A listing of the sections that can be substituted for other specific sections; and (iii) The filing fee required under Insurance Article, §2-112, Annotated Code of Maryland , for each section with a unique form number. (2) A carrier may not file for approval of sections for use with a previously approved contract, if the previously approved contract was not approved on a sectional basis. (3) If a carrier files for approval of sections for a previously approved contract, the submission shall: (a) Identify by form number and date of approval any sections that the new sections will replace; and (b) Include a copy of the currently approved contract, unless the Commissioner waives the requirement or determines that a copy is not necessary to review the submission.

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.05 Failure to Respond to the Commissioner's Correspondence. A. The Commissioner shall deem a filing withdrawn by the carrier if the carrier 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 a carrier 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 carrier shall: (1) Include a new filing fee for the form and associated premium rates included in the filing; and (2) Include in the filing all the information required in Regulation .03 of this chapter .

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.06 Contents of Application Forms. A. An application form shall stipulate the plan and amount of insurance and any added optional benefits being applied for. B. If the carrier uses an application form which contains language substantially as follows, "Except that no change in amount, classification, plan of insurance or benefits shall be effective unless agreed to in writing by the applicant", with an additional statement that this exception is effective only in certain states, the form shall specifically name Maryland as one of the states in which the exception is effective. C. If an application inquires about the applicant's participation in "hazardous activities", the application shall list the activities that are considered to be "hazardous". D. If an application inquires about the applicant's use of "other habit-forming drugs", the application shall list the specific drugs that are considered "habit-forming". E. If an application contains questions regarding past or present health conditions: (1) The questions shall be asked to the best of the applicant's knowledge and belief; or (2) The application shall include a statement that all of the answers provided are representations and are not warranties. F. If an application inquires about a symptom of an applicant, the question shall be asked about a "known symptom" of a physical condition or mental condition. G. If an application inquires if an applicant has had any indication of a physical condition or mental condition, the question shall be asked about a "known indication" of a physical condition or mental condition. H. Applications for Individual Insurance. (1) If an application is to be used by more than one carrier, the application shall include check-off boxes to indicate the carrier to which application is being made. (2) Each carrier using the application shall: (a) File the application with the Commissioner for approval; and (b) Receive approval of use of the application from the Commissioner before using it in Maryland. I. Applications for Group Insurance. (1) A group application may be used by more than one carrier if each carrier using the application shall: (a) File the application with the Commissioner; and (b) Receive approval of the application from the Commissioner before using it in Maryland. (2) If more than one carrier requests approval to use the same application with different group applicants, the application shall include check-off boxes to indicate the carrier to which application is being made. (3) Group Applications for Multiple Carriers. (a) A group application may be designed to be used by: (i) More than one carrier; (ii) A carrier and a health maintenance organization; or (iii) Multiple carriers and a health maintenance organization. (b) A group application described in §I(3)(a) of this regulation shall clearly identify the coverage underwritten by each carrier or health maintenance organization. J. If an application is to be completed by more than one individual, the signature box in the application shall clearly indicate that the signature applies only to the portion of the application completed by that individual.

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.07 Advertising Material Within a Form. A. A form may not contain any advertising material. B. A carrier may use a marketing name, registered trademark, or logo in a form, if the logo, registered trademark, or marketing name does not mislead as to the identity of the carrier. C. A carrier may include text such as "50th Anniversary Year", "Established over 100 Years", or "Incorporated 1860" in a form.

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.08 Proxy. A statement may not appear in the application with respect to a proxy through which one or more members of the board of directors is authorized to vote in the election of directors.

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.09 Life Insurance Policies. A. In the case of term policies, the insurer shall indicate in clear, unambiguous language, whether or not coverage is granted if loss occurs on the term expiry date. Some examples of acceptable language are: (1) If death occurs on or before the 5th anniversary of the policy, etc.; (2) If death occurs before but not including, the 5th anniversary of the policy, etc.; (3) This policy shall terminate on the 5th anniversary of the date of issue at 12:00 o'clock noon Standard Time at the place where the insured then resides. B. In the case of a renewable term life insurance policy (that is, a term policy containing an option on the part of the policyholder to renew for one or more further periods of term insurance), the actual premiums to be charged at each renewal date shall be shown in the policy. In a policy of wholesale or group term life insurance, however, the insurer may reserve the right to change the table of renewal premiums on any policy anniversary on 30 days' notice. C. If the brief description of a policy indicates that the policy is renewable or convertible, or both, the brief description shall further indicate the term during which the policyholder may exercise the option to renew or convert, or both, unless this option may be exercised during the entire term of the policy or renewal of the policy. D. In the case of a convertible term life insurance policy issued on a participating basis, if there is a provision for the computation of the cost of change on the basis of difference in premiums (or premiums plus interest), the cost of change also shall provide for adjustment in dividends. E. If a life insurance policy contains a war or aviation exclusion, or both, a printed or stamped statement shall appear as part of the brief description on the first page of the policy reading "War Restrictions Included", "Aviation Exclusions Included", "War and Aviation Restrictions Included", or any similar language approved by the Commissioner.

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.10 General Requirements for Forms. A. If a carrier embodies a brief description on the filing back of a form, the brief description shall be identical in language with that embodied on the first page of the form. B. An application, policy, or contract may not require a warranty of the state of health of the insured or that the good health of the insured be a condition precedent to the policy or contract.

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.11 Self-Destruction or Self-Inflicted Injury. A. In any group life insurance policy, or in any provisions in either a life insurance policy or a certificate relating to additional disability benefits or to additional benefits in the event of death by accident or accidental means: (1) If the insurer desires to exclude self-destruction or self-inflicted injury, or both, regardless whether intentional or unintentional, language such as "self-destruction and/or self-inflicted injury, intentional or unintentional" or "self-destruction and/or self-inflicted injury, voluntary or involuntary", should be used. (2) If the insurer desires to exclude only suicide or intentional self-inflicted injury, or both, language such as "suicide", "intentional self-destruction", "voluntary self-destruction", "intentional self-inflicted injury", and/or "voluntary self-inflicted injury" should be used. The insurer, at its option, may also add the language "while sane or insane". B. In nonprofit health service plan forms and health insurance forms, including certificates of health insurance issued by fraternal benefit societies, the carrier may not exclude unintentional self-destruction or unintentional self-inflicted injury, but may exclude self-destruction or self-inflicted injury by an insane person.

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.12 Military Service Exclusion. A. Except as provided in §B of this regulation , a contract shall provide for a refund of premium upon request of the policyholder of pro rata unearned premium for any period during which the insured is not covered if: (1) Coverage terminates for an individual when the individual enters military service; or (2) The contract excludes any coverage while the individual is in military service. B. The refund of premium requirement described in §A of this regulation does not apply to: (1) A group contract; (2) An individual contract that contains a military exclusion that applies only to loss resulting from military service while in the military service; (3) An individual life insurance contract that provides for automatic reinstatement: (a) Upon discharge from military service; or (b) Within a stated period not exceeding 6 months after discharge; or (4) An individual health insurance or nonprofit health service plan contract, if: (a) The contract is a noncancellable contract or a guaranteed renewable contract; and (b) The contract provides for automatic reinstatement: (i) Upon discharge from military service; or (ii) Within a stated period not exceeding 6 months after discharge.

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.13 Prohibited Coverage. A. Health Insurance Coverage Prohibited in Individual Life Insurance Policies. An ordinary or industrial life insurance policy may not include a health insurance benefit, except for the following types of benefits: (1) Long-term care coverage; (2) Accidental death and dismemberment coverage; (3) Waiver of premium for permanent disability coverage; (4) Acceleration of death benefit for terminal illness or chronic condition; (5) Benefits for a second opinion for health conditions specified in the policy; or (6) Benefits that: (a) Provide a lump-sum benefit for a disease specified in the policy; and (b) Meet the requirements established by the Commissioner under Insurance Article, §15-109, Annotated Code of Maryland . B. Natural Death Benefit Prohibited in Individual Health Insurance Policies. (1) Except as provided in §B(2) of this regulation , a health insurance policy subject to Insurance Article, Title 15, Subtitle 2, Annotated Code of Maryland , or any supplementary benefit under such a policy, may not provide a natural death benefit. (2) A disability income policy may provide a survivor benefit, provided the survivor benefit does not exceed 3 times the last full monthly disability income benefit.

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.14 Standard Nonforfeiture Value Method. The expression "standard nonforfeiture value method" is acceptable for the description of the method of determining a cash value by deducting from the present value of future benefits, the present value of future nonforfeiture factors or adjusted premiums. When using this expression, it is necessary to state the amount of the nonforfeiture factor for the particular policy. If the nonforfeiture factor is identical with the statutory adjusted premium, the following language is acceptable if applicable: "The cash value under this policy as of any policy anniversary is the amount computed in accordance with the standard nonforfeiture value method using the adjusted premium as defined in the laws of the State in which this policy is delivered".

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.15 Recommendations of National Association of Insurance Commissioners. The Commissioner shall be guided by recommendations made by a subcommittee of the National Association of Insurance Commissioners in those instances where: A. The question of the computation of minimum cash values for a particular type of policy or type of insurance coverage has been made the subject of a study by the subcommittee of the National Association of Insurance Commissioners; and B. Maryland does not have a specific regulation covering the question described in §A of this regulation .

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.16 Use of Dividends. In a participating life insurance policy or certificate, if dividends may be used to purchase additional term or paid-up insurance, the policy shall specify the basis of the maximum charge for the purchase of this insurance.

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.17 Riots and Altercations. A. Life Insurance. If a life insurance form excludes liability for injury or accidental death arising out of: (1) A riot, the exclusion shall be confined to cases in which the insured is participating in the riot; and (2) An altercation, the exclusion shall be confined to cases in which the insured provoked the altercation. B. Health Insurance. Exclusions or limitations for riots or altercations in health insurance and nonprofit health service plan contracts shall comply with the applicable provisions found in COMAR 31.10.25.05A , COMAR 31.10.28.03A , and COMAR 31.11.10.06A .

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.18 Health Insurance—Pre-Existing Condition Exclusions. For health insurance contracts or contracts issued by a nonprofit health service plan, a carrier may not impose a pre-existing condition exclusion that exceeds 1 year if the application does not include medical questions or health history questions.

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Previous Chapter 16 Filing of Underwriting Standards

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Next Chapter 18 Form Filings Under the Maryland Insurance Acquisitions Disclosure and Control Act

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