<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="12-102" title_number="12" title_name="Policy Forms and Provisions" subtitle_number="1" subtitle_name="General Provisions">
  <level label="a">
    <text>Except as provided in subsection (b)(1) of this section, an insurance contract or annuity contract shall contain the standard provisions required under this article.</text>
  </level>
  <level label="b">
    <level label="1">
      <text>The Commissioner may waive the required use of a provision in an insurance policy or contract form if the Commissioner:</text>
      <level label="i">
        <text>finds that the provision is unnecessary to protect the insured or is inconsistent with the purposes of the policy; and</text>
      </level>
      <level label="ii">
        <text>approves the policy.</text>
      </level>
    </level>
    <level label="2">
      <text>A required standard provision may not be waived by agreement between an insurer and another person.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <level label="i">
        <text>In this subsection the following words have the meanings indicated.</text>
      </level>
      <level label="ii">
        <text>“Carrier” means:</text>
        <level label="1">
          <text>an insurer authorized to sell health insurance;</text>
        </level>
        <level label="2">
          <text>a nonprofit health service plan;</text>
        </level>
        <level label="3">
          <text>a health maintenance organization; or</text>
        </level>
        <level label="4">
          <text>any other entity providing a plan of health insurance, health benefits, or health services authorized under this article or the Affordable Care Act.</text>
        </level>
      </level>
      <level label="iii">
        <text>“Enrollee” means an individual entitled to benefits from a carrier’s health benefit plan.</text>
      </level>
      <level label="iv">
        <text>“Health benefit plan” has the meaning stated in § 15–1301 of this article.</text>
      </level>
    </level>
    <level label="2">
      <text>Each health benefit plan issued by a carrier shall include provisions that:</text>
      <level label="i">
        <text>permit enrollees a minimum of 1 year after the date of service to submit a claim for the service;</text>
      </level>
      <level label="ii">
        <text>provide that:</text>
        <level label="1">
          <text>an enrollee’s legal incapacity shall suspend the time to submit a claim; and</text>
        </level>
        <level label="2">
          <text>the suspension period ends when legal capacity is regained; and</text>
        </level>
      </level>
      <level label="iii">
        <text>provide that the failure to submit a claim within 1 year after the date of service does not invalidate or reduce the amount of the claim if:</text>
        <level label="1">
          <text>it was not reasonably possible to submit the claim within 1 year after the date of service; and</text>
        </level>
        <level label="2">
          <text>the claim is submitted within 2 years after the date of service.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="d">
    <text>The Commissioner may approve a substitute provision in an insurance policy or annuity contract if the provision is not less favorable than the required provision to the insured, annuitant, or beneficiary.</text>
  </level>
  <level label="e">
    <text>Instead of a provision required by this article, a foreign insurer or alien insurer may use a substantially similar provision required by the law of the foreign insurer’s or alien insurer’s domicile if the substantially similar provision does not conflict with the law of this State.</text>
  </level>
  <level label="f">
    <text>A policy or contract may not contain a provision that is inconsistent with a standard provision used or required to be used.</text>
  </level>
</section>
