Administrative History Effective date: January 14, 2010 (37:1 Md. R. 16) Authority Health-General Article, §§19-705(a)(2), and 19-729; Insurance Article, §§ 2-109 (a)( 1 ), 4-113 , and 12-20 ; Annotated Code of Maryland

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.01 Purpose. The purpose of this chapter is to establish time frames in which carriers are required to provide: A. Health insurance contracts, nonprofit health service plan contracts, health maintenance organization contracts, and dental plan organization contracts to individual contract holders and group contract holders; and B. Health insurance certificates, nonprofit health service plan certificates, health maintenance organization certificates, and dental plan organization certificates to certificate holders.

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.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) "Blanket insurance" has the meaning stated in Insurance Article, §15-305, Annotated Code of Maryland . (2) "Carrier" means any of the following: (a) An insurer; (b) A nonprofit health service plan; (c) A health maintenance organization; and (d) A dental plan organization. (3) "Certificate" or "summary plan description" means the benefit summary that sets forth the essential elements of a group contract and that is required to be provided by a carrier to individuals covered under a group contract. (4) "Certificate holder" means an individual who is eligible to be covered under a group contract by reason of satisfying the eligibility requirements of the group contract, other than an individual who is covered under a group contract as the spouse, domestic partner, or dependent of the certificate holder. (5) "Contract holder" means the entity to whom a contract is issued. (6) "Group contract" means a health insurance contract, a nonprofit health service plan contract, a health maintenance organization contract, or a dental plan organization contract issued by a carrier to a group for the purpose of covering: (a) Employees or members of the group; (b) The dependents of employees or members of the group; or (c) The employees, or members of the group, and the employee's, or member's dependents. (7) "Health insurance" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland . (8) "Individual contract" means a health insurance contract, a nonprofit health service plan contract, a health maintenance organization contract, or a dental plan organization contract issued by a carrier to a contract holder covering: (a) The contract holder; (b) The contract holder's dependents; or (c) The contract holder, and the contract holder's dependents. (9) "Insurance producer" has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland .

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.03 Delivery Requirements for Contracts and Policies. A. Except as described in §B of this regulation , a carrier shall deliver an individual health insurance contract, an individual nonprofit health service plan contract, an individual health maintenance organization contract, or an individual dental plan organization contract to the contract holder within 60 days of the effective date of the contract. B. If a carrier back dates an individual health insurance contract so that the individual health insurance contract is written at a younger age, the carrier shall deliver the individual health insurance contract to the contract holder within 60 days of the later of the: (1) Effective date of the individual health insurance contract; or (2) Date the carrier approves the application for the individual health insurance contract. C. A carrier shall deliver a group or blanket health insurance contract, a group nonprofit health service plan, a group health maintenance organization contract, or a group dental plan organization contract to the contract holder within 60 days of the later of the: (1) Effective date of the contract; or (2) Date the contract holder provides all the information needed to finalize the benefits offered under the contract.

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.04 Delivery Requirements for Certificates. A. A carrier shall deliver a certificate under a group health insurance contract, a group nonprofit health service plan contract, a group health maintenance organization contract, or a group dental plan organization contract to the: (1) Certificate holder within 60 days of the effective date of the certificate holder's coverage; or (2) Group contract holder within 60 days of the effective date of the certificate holder's effective date of coverage, for delivery to each certificate holder. B. A carrier may satisfy the requirement of §A of this regulation by making the certificate available to the certificate holder on the Internet, if: (1) Written notice of the availability of the certificate on the Internet is provided to the: (a) Certificate holder in writing within 60 days of the date of the certificate holder's effective date of coverage; or (b) Group contract holder or insurance producer of record within 60 days of the effective date of the certificate holder's effective date of coverage, for the group contract holder or insurance producer of record to provide delivery to the certificate holder; and (2) The written notice described in §B(1) of this regulation includes an option for the certificate holder to request the certificate be delivered to the certificate holder by mail. C. The certificate requested under §B of this regulation shall be made available in paper form within 60 days of the receipt by the carrier of the request for the paper certificate from the certificate holder. D. If a carrier cannot comply with the requirements of §A of this regulation because the group contract holder delays providing the necessary information to the carrier to issue the certificate, the carrier's time limit to provide the certificate is extended to the shorter of: (1) 30 days from the date the employer group provides the information to the carrier; or (2) 120 days from the effective date of the employer group contract.

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.05 Compliance. Failure of a carrier to deliver a contract or certificate as provided in Regulations .03 and .04 of this chapter shall constitute: A. A violation of Insurance Article, §4-113, Annotated Code of Maryland , for a carrier, other than a health maintenance organization; or B. A violation of Health-General Article, §19-729, Annotated Code of Maryland, for a health maintenance organization.

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Previous Chapter 36 Pharmacy Benefit Managers — Approval of an Accrediting Organization

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Next Chapter 38 Wellness Program Incentives

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