Administrative History Effective date: Regulations .01 — .04 adopted effective January 1, 2016 (42:23 Md. R. 1436) Authority Insurance Article, §§ 2-109 (a)( 1 ) and 15-129 (f)( 3 ), Annotated Code of Maryland

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.01 Scope. This chapter applies to carriers that sell medical stop-loss insurance to small employers in Maryland.

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.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Carrier” means an insurer or nonprofit health service plan that sells medical stop loss insurance in Maryland. (2) “Medical stop-loss insurance” has the meaning stated in Insurance Article, §15-129, Annotated Code of Maryland . (3) “Medical stop-loss insurance disclosure form” means the form shown in Regulation .04 of this chapter . (4) “Small employer” has the meaning stated in Insurance Article, §31-101, Annotated Code of Maryland .

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.03 Rules for Providing the Medical Stop-Loss Insurance Disclosure Form. A. Before entering into a policy or contract of medical stop-loss insurance with a small employer, a carrier shall provide the small employer a completed medical stop-loss insurance disclosure form. B. When determining whether an employer satisfies the definition of a small employer, the carrier shall base the determination on the definition that applies on the proposed effective date of the medical stop-loss insurance policy or contract. C. The medical stop-loss insurance disclosure form shall be printed in at least 12-point type. D. The portion of the medical stop-loss insurance disclosure form that requires a listing of any limitations in the medical stop-loss insurance policy or contract is required to include any: (1) Dollar limitations in the medical stop-loss insurance policy or contract, such as annual limitations; (2) Day or visit limits on the services covered under the medical stop-loss insurance policy or contract; (3) Limitations or exclusions that apply to benefits covered under the medical stop-loss insurance policy or contract, such as: (a) Pre-existing condition exclusions; (b) Exclusions or limitations for particular services, such as an exclusion or limitation for prescription drugs or mental health services; (c) Exclusions or limitations for particular medical conditions, such as AIDS; (d) Limitations or exclusions for non-medically necessary services; and (e) Limitations or exclusions for experimental or investigational services; and (4) Different attachment points for any particular service, such as organ transplants.

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.04 Medical Stop-Loss Insurance Disclosure Form. The medical stop-loss insurance disclosure form shall read as follows:

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FORM AT END OF CHAPTER

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Attachments 31.10.43.04-form

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31.10.43.04-form

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Previous Chapter 42 Continuity of Health Care Notice

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Next Chapter 44 Network Adequacy

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