COMAR 31.04.19 · Chapter 19 Filing of Forms Under File and Use Method

Administrative History Effective date: July 17, 2006 (33:14 Md. R. 1165) Regulation .02B amended effective June 20, 2016 (43:12 Md. R. 668) Regulation .05B amended effective June 20, 2016 (43:12 Md. R. 668) Authority Insurance Article, §§ 2-109 and 12-203 (d)( 2 ), Annotated Code of Maryland

¶14

.01 Applicability and Scope. This chapter applies to the submission of any form required to be filed under Insurance Article, §12-203(b), Annotated Code of Maryland .

¶15

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) "Accidental death policy" means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death of an insured. (2) "Accidental death and dismemberment policy" means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death or dismemberment of an insured. (3) "Administration" means the Maryland Insurance Administration. (4) "Annuity" has the meaning defined in Insurance Article, §1-101, Annotated Code of Maryland . (5) Application. (a) "Application" means the form used to apply for insurance. (b) "Application" includes: (i) Group applications and enrollment forms; and (ii) Individual applications. (6) Blanket Health Insurance. (a) "Blanket health insurance" has the meaning stated in Insurance Article, §15-305, Annotated Code of Maryland . (b) "Blanket health insurance" does not include a contract or policy for which a covered individual is required to complete an application. (7) "Commissioner" means the Maryland Insurance Commissioner. (8) "Credit life insurance" has the meaning stated in Insurance Article, §13-101, Annotated Code of Maryland . (9) Employer Retrospective Premium Arrangement. (a) "Employer retrospective premium arrangement" means a rider to an employer group health insurance contract that provides that the employer may pay a negotiated reduced premium during the plan year, in accordance with a methodology approved by the Administration, with an adjustment at the end of the plan year based on the actual experience of the employer's group. (b) "Employer retrospective premium arrangement" does not include any rider used with a small employer health benefit plan. (10) Expense Incurred. (a) "Expense incurred" means the benefits payable under the health insurance contract are based on the medical expenses the insured incurs. (b) For the purposes of this chapter, a health insurance contract that includes both expense incurred benefits and indemnity benefits shall be considered to be written on an expense incurred basis. (11) "File and use method" means the method prescribed by the Commissioner which permits an insurer to file forms prescribed in Regulation .05 of this chapter and begin using the form at the earlier of: (a) 30 days after the date the forms are received by the Commissioner, provided the forms are not disapproved by the Commissioner within this 30 day period; or (b) The date the insurer receives notice from the Commissioner that the filing has been accepted. (12) "Final disposition" means approval, disapproval or withdrawal of a form submitted for approval. (13) Form. (a) "Form" means: (i) A policy; (ii) A certificate; (iii) A contract; (iv) A rider; (v) An endorsement; (vi) An amendment; or (vii) An application. (b) "Form" includes: (i) An insert page to a contract, if the insurer complies with the insert page filing requirements for contractsS on an insert page basis found in COMAR 31.04.17.04B ; and (ii) A section of a contract, if the insurer complies with the section filing requirements for contracts on a sectional basis found in COMAR 31.04.17.04C . (14) "Health benefit plan" has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland . (15) "Health insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (16) "Indemnity" means the benefits payable under the health insurance contract are flat amounts that are not related to the expenses the insured incurs, such as a hospital indemnity contract that pays a flat fee for each day the insured is confined in a hospital regardless of the actual expenses the insured incurs during the hospital confinement. (17) "Insurer" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (18) "Life insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (19) "Long term care insurance" has the meaning stated in Insurance Article, §18-101, Annotated Code of Maryland . (20) "Medical stop-loss insurance" has the meaning stated in Insurance Article, §15-129(a), Annotated Code of Maryland . (21) "Medicare supplement policy" has the meaning stated in Insurance Article, §15-901, Annotated Code of Maryland . (22) "Noncompliant" means a form is not in compliance with Maryland statutes and regulations. (23) "Prior approval method" means the method that insurers use to file forms with the Commissioner in which the forms may not be used in Maryland by the insurer until the forms are approved by the Commissioner. (24) "Small employer" has the meaning stated in Insurance Article, §31-101, Annotated Code of Maryland . (25) "Wholesale life insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland .

¶16

.03 Filing of Forms for Approval. Except as otherwise provided in this chapter, the filing of forms shall be in compliance with the requirements under: A. COMAR 31.04.17 for life and health insurance filings; and B. COMAR 31.10.01 for health insurance filings.

¶17

.04 Submission Requirements for File and Use Method. A. An insurer may request that a form filing be accepted under a file and use method. B. The cover letter included with forms filed under the file and use method shall include the following: (1) A reference line that indicates that the forms are being filed under the file and use method; (2) A list of the forms included in the submission; and (3) For each form listed in the cover letter required under §B(2) of this regulation , a cite to the authority to file the form under Regulation .05 of this chapter . C. The use of the file and use method shall be limited in accordance with the types of forms specified in Regulation .05 of this chapter . D. An insurer may not combine in the same submission: (1) Forms filed under the file and use method; and (2) Forms filed under the prior approval method. E. A request under a file and use method shall include a signed certification from a responsible officer that, to the best of the officer's knowledge and belief, the forms comply with applicable statutes and regulations. F. A filing made under a file and use method shall be subject to the same filing fee requirements applicable to filings made under a prior approval method. G. An insurer may issue a form for delivery in Maryland that was filed under the file and use method at the earlier of the following dates: (1) 30 days after the date the form has been received by the Commissioner, provided the Commissioner has not previously disapproved the filing; or (2) The date the insurer receives written notice from the Commissioner that the filing has been accepted under the file and use method. H. An insurer may not use the file and use method before the insurer has had a certificate of authority to write the same type of coverage in Maryland for at least 12 months. I. An insurer may not use the file and use method to file a form in Maryland if: (1) The form has previously been disapproved by the Commissioner; (2) The form has been previously filed for approval with the Commissioner under the prior approval method and is still pending final disposition with the Commissioner; or (3) The Commissioner has decided that the form has been previously withdrawn by the insurer in accordance with COMAR 31.04.17.05 .

¶18

.05 Types of Forms Used on a File and Use Method. A. The forms listed in §B of this regulation are the only forms that may be used on a file and use basis. B. The following life insurance, health insurance, and annuity forms may be filed under the file and use method: (1) Group life insurance policies and certificates, except for group credit life insurance policies and certificates; (2) Endorsements, amendments, and riders to be used with group life insurance policies and certificates, except for endorsements, amendments, and riders to be used with group credit life insurance policies and certificates; (3) Wholesale life insurance policies; (4) Endorsements, amendments, and riders to be used with wholesale life insurance policies; (5) Accidental death benefit riders to be used with individual life insurance policies; (6) Waiver of premium riders to be used with individual life insurance policies; (7) Accidental death and dismemberment riders to be used with individual life insurance policies; (8) Riders to be used with individual life insurance policies that provide coverage to the spouse or dependent children of the insured; (9) Guaranteed insurability option riders to be used with individual life insurance policies; (10) Group annuity contracts and certificates, including variable and nonvariable group annuity contracts and certificates; (11) Endorsements, amendments, and riders to be used with group annuity contracts and certificates; (12) Individual retirement account (IRA) endorsements to be used with individual fixed annuity contracts or with individual variable annuity contracts; (13) Tax sheltered annuity (TSA) endorsements to be used with: (a) Individual fixed annuity contracts; or (b) Individual variable annuity contracts; (14) Medical stop-loss insurance; (15) Group accidental death policies and certificates; (16) Group accidental death and dismemberment policies and certificates; (17) Group travel health insurance policies and certificates, except for the following: (a) Any form that includes lost baggage benefits; (b) Any form that includes a trip cancellation benefit that is payable for a reason other than the illness or death of: (i) The insured; (ii) A member of the insured's family; or (iii) One or more of the insured's travel companions; or (c) Any form that contains any other property or casualty type benefit not included in §B(17)(a) and (b) of this regulation; (18) Group health insurance policies and certificates that: (a) Limit coverage to losses due to accident; and (b) Do not pay benefits on an expense-incurred basis; (19) Employer retrospective premium arrangements; (20) Blanket health insurance policies that limit benefits to accidental death benefits; (21) Blanket health insurance policies that limit benefits to accidental death and dismemberment benefits; (22) Blanket health insurance policies that limit benefits to travel benefits; (23) Blanket health insurance policies that: (a) Limit coverage to losses due to accident; and (b) Do not pay benefits on an expense-incurred basis; and (24) Applications, except applications for: (a) Medicare supplement policies; (b) Long-term care insurance; (c) Individual health benefit plans; and (d) Small employer health benefit plans.

¶19

.06 Use of Noncompliant Forms. A. If an insurer uses a form which becomes effective under a file and use method and the form is found by the Commissioner to be noncompliant, the Commissioner may: (1) Disapprove the form by: (a) Giving notice of the disapproval; (b) Showing cause for the disapproval; and (c) Stating the effective date of the disapproval in the notice; and (2) Impose a penalty as provided under Insurance Article, §4-113, Annotated Code of Maryland . B. The Commissioner may remove file and use authority from an insurer upon a finding that the insurer has made inappropriate or noncompliant filings under this method with such frequency as to constitute a business practice.

¶20

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

¶21

Next Chapter 20 Market Conduct Actions

¶22

This version of the laws and codes on this website is licensed under the CC BY-NC-SA 4.0 license with copyright held by the State of Maryland. This version of the laws and codes on this website will be dedicated to the public domain under the CC0 1.0 license 180 days after publication.

¶23

Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0 HTML or XML or CC0 HTML or XML . Powered by the non-profit Open Law Library .