Administrative History Effective date: March 30, 1992 (19:6 Md. R. 672) —————— Chapter recodified from COMAR 09.30.36 to COMAR 31.10.02 effective September 7, 1998 (25:18 Md. R. 1439) Authority Insurance Article, §§ 2-109 , 12-102 — 12-104 , 12-107 , 12-203 — 12-205 , 12-209 , 15-103 , 15-201 , 15-202 , 15-402 , 15-502 , 15-916 , 15-919 , and 15-924 , Annotated Code of Maryland

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.01 Applicability. A. This chapter does not apply to: (1) Group health insurance policies initially issued to employer/employee groups of more than 1,000 employees; (2) Group health insurance policies issued pursuant to a collective bargaining labor-management agreement; or (3) Reinsurance contracts. B. Except as provided in §A of this regulation , this chapter applies to all health insurance policies, including riders, endorsements, and certificates, issued or delivered in this State by any insurer or nonprofit health service plan. C. The Insurance Commissioner may except other policies from the requirements of this chapter if the Commissioner determines that an exception is warranted by the nature of the particular policy form or if the policy language is drafted to conform to requirements of any other applicable law or regulation.

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.02 Minimum Standards. A. In addition to any other requirements or law, a policy form to which this chapter is applicable may not be issued or delivered in this State unless: (1) The text achieves a minimum score of 40 on the Flesch Reading Ease Test; (2) The policy contains a table of contents or an index of the principal sections of the policy if it has more than 3,000 words or more than three pages regardless of the number of words; (3) The style, arrangement, and overall appearance of the policy do not give undue prominence to any portion of the text or to any endorsements or riders; and (4) Except for specification pages, schedules, tables, and tables of contents, if any, the policy is plainly printed in a style in general use and the size is uniform and not less than 10-point type, 1-point leaded, with a lower case alphabet length not less than 120 point. B. If any provision of Insurance Article, Annotated Code of Maryland , requires that any particular section of a policy or any particular type of policy be printed in larger type style or with greater prominence, then the provisions of the Insurance Article prevail over the requirements of these regulations.

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.03 Flesch Reading Ease Test Scores. A. The Flesch Reading Ease Test scores shall be calculated according to the requirements of §§B—F of this regulation. B. For policy forms containing 10,000 words or less of text, the entire form shall be analyzed. For policy forms containing more than 10,000 words, the readability of two 200-word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least 20 printed lines. C. The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015. D. The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6. E. The sum of the figures computed in §§C and D of this regulation, subtracted from 206.835, equals the Flesch Reading Ease Test Score for the policy form. F. For purposes of §§C—E of this regulation, the following procedures shall be used: (1) A contraction, hyphenated word, or number or letter separated by spaces is counted as one word; (2) A unit of words ending with a period, semicolon, or colon, but excluding headings and captions, is counted as one sentence; and (3) A syllable means a unit of spoken language consisting of one or more letters of a word as divided by a commonly accepted dictionary, although when the dictionary shows two or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used. G. The Flesch Reading Ease Test shall be applied to all printed matter in the policy, except for: (1) The name and address of the insurer, policy number, name or title of policy, table of contents or index, specification pages, schedules, tables, captions, and subcaptions; and (2) Medical terminology, language which is drafted to conform to the requirements of any applicable law or regulation, language required by a collective bargaining labor-management agreement, or terms defined in the policy. H. At the option of the insurer, riders, endorsements, and other forms which are attached to and made a part of the policy may be scored separately or as part of the policy with which they are to be used.

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.04 Certification. A policy form to which these regulations apply, and which is required to be submitted for approval in accordance with Insurance Article, §§ 12-203 and 12-205 , Annotated Code of Maryland, shall be accompanied by a certificate signed by an officer of the insurer stating that the language of the form has been measured by the Flesch Reading Ease Test, and giving the resulting score achieved on that test. If any language has been omitted from the test in accordance with Regulation .03G(2) of this chapter , the certificate shall so specify.

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.05 Effective Date. A. These regulations apply to all health insurance policies, certificates, riders, and endorsements submitted for approval on or after January 1, 1992. B. If any policy form, certificate, rider, or endorsement which does not comply with the minimum standards of Regulation .02 of this chapter has been submitted for approval before January 1, 1992, and approved by the Commissioner, it may be issued or delivered in this State until January 1, 1997, but not after that unless it has been submitted or resubmitted in accordance with the requirements of these regulations. A policy form, certificate, rider, or endorsement submitted before January 1, 1992, which complies with the minimum standards of Regulation .02 of this chapter need not be resubmitted.

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Next Chapter 03 Health Insurance — Stop-Loss Coverage [Repealed]

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