Title 15. Health Insurance — Subtitle 2. Individual Health Insurance Policy Forms and Provisions
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-201 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–201LinkCopy Citation
(a)
A policy of health insurance may not be delivered or issued for delivery in the State unless the policy complies with the provisions of this section and other sections of this article.
(b)
Each policy of health insurance shall state explicitly:
(1)
any consideration, including the entire amount of money, given for the policy; and
(2)
the time when the health insurance takes effect and terminates.
(c)
(1)
Except as provided in paragraph (2) of this subsection, each policy of health insurance shall purport to insure only one individual.
(2)
On application by an adult member of a family, a policy of health insurance may insure, originally or by subsequent amendment:
(i)
the applicant, who is deemed the policyholder; and
(ii)
two or more eligible members of the policyholder’s family, including a spouse, dependent child, any other child under a specified age not exceeding 18 years, and any other individual dependent on the policyholder or any other individual related to and resident in the household of the policyholder.
(d)
(1)
In this subsection, “text” includes all printed matter of a policy except the name and address of the insurer, name or title of the policy, any brief description, captions, and subcaptions.
(2)
The style, arrangement, and overall appearance of a policy may not give undue prominence to any part of the text.
(3)
Each printed part of the text and of any endorsements or attached papers shall be printed plainly in lightfaced type:
(i)
of a style in general use; and
(ii)
in a size that is uniform and not less than 10 point with a lower case unspaced alphabet length not less than 120 point.
(e)
(1)
The exceptions and reductions of indemnity shall be set forth in the policy.
(2)
Other than those contained in §§ 15-207 through 15-226 of this subtitle, and except as provided in paragraph (3) of this subsection, the exceptions and reductions shall be printed at the insurer’s option:
(i)
with the benefit provisions to which they apply; or
(ii)
under an appropriate caption such as “Exceptions” or “Exceptions and Reductions”.
(3)
If an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction shall be included with the benefit provision to which it applies.
(f)
Each form of a policy, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page.
(g)
(1)
Except as provided in paragraph (2) of this subsection, a policy may not contain a provision that purports to incorporate in the policy a part of the charter, rules, constitution, or bylaws of the insurer unless the part is set forth in full in the policy.
(2)
A statement of rates, classification of risks, or short-rate table that is filed with the Commissioner may be referred to or incorporated in the policy without being set forth in full.
(h)
(1)
Subject to paragraph (2) of this subsection, a notice shall be prominently printed on or attached to the face of the policy that states that:
(i)
the policy may be surrendered to the insurer for cancellation within 10 days after the date the policy is delivered to the insured; and
(ii)
if a policy is canceled during the 10-day period, a pro rata premium for the unexpired term of the policy shall be returned to the insured.
(2)
The insured shall notify the insurer of the cancellation in writing.
(3)
The insurer may print or attach the notice required under paragraph (1) of this subsection or a notice of equal prominence that, in the opinion of the Commissioner, is not less favorable to the policyholder.
(i)
A policy that is subject to renewal at the option of the insurer shall contain a notice of this provision prominently printed on the first page of the policy.
Md. Code Ann., Ins. § 15-202 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–202LinkCopy Citation
(a)
Except as otherwise provided in this section, each policy of health insurance that is delivered or issued for delivery in the State:
(1)
shall contain the exact language of each provision that is required under §§ 15-207 through 15-218 of this subtitle and any optional provision in §§ 15-207 through 15-226 of this subtitle that is used; and
(2)
shall contain each mandatory provision and any optional provision that is used:
(i)
in the order in which those provisions appear in this subtitle; or
(ii)
as individual items in any part of the policy with other provisions to which they may be logically related, if the resulting policy is not wholly or partly unintelligible, uncertain, or likely to mislead a person to whom the policy is offered, delivered, or issued.
(b)
The insurer may substitute a corresponding provision with different wording for a provision set forth in this subtitle if the corresponding provision is approved by the Commissioner and is not less favorable in any respect to the insured or beneficiary.
(c)
If a provision specified in §§ 15-207 through 15-218 of this subtitle is wholly or partly inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the Commissioner, shall:
(1)
omit from the policy the inapplicable provision or part of the provision; or
(2)
modify the inconsistent provision or part of the provision to make it consistent with the coverage provided by the policy.
(d)
Each provision shall be preceded individually by the applicable caption shown or, at the option of the insurer, by an appropriate individual or group caption or subcaption that the Commissioner approves.
Md. Code Ann., Ins. § 15-203 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–203LinkCopy Citation
Other than a policy of accident only insurance, each policy of health insurance in which the insurer reserves the right to refuse renewal on an individual basis shall contain a provision, endorsement, or rider that provides in substance:
(1)
that, subject to the right to terminate the policy on nonpayment of premium when due, the right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the policy;
(2)
that a refusal to renew shall be without prejudice to any claim that originates while the policy is in effect;
(3)
that a renewal may not be refused solely because of a change in the health or physical or mental condition of the insured; and
(4)
unless omitted at the insurer’s option, that the right to refuse renewal of a policy of health insurance that was reinstated after lapse may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement.
Md. Code Ann., Ins. § 15-204 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–204LinkCopy Citation
(a)
If a policy of health insurance establishes, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and the date falls within a period for which the insurer accepts a premium for the policy, or if the insurer accepts a premium for the policy after that date, the coverage provided by the policy continues in effect until the end of the period for which the insurer has accepted the premium.
(b)
If the age of the insured is misstated and, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased before the acceptance of a premium for the policy, the liability of the insurer is limited to the refund, on request, of the premiums paid for the period not covered by the policy.
Md. Code Ann., Ins. § 15-205 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–205LinkCopy Citation
(a)
A policy of a foreign insurer or alien insurer that is delivered or issued for delivery in the State may contain a provision that:
(1)
is not less favorable to the insured or beneficiary than the provisions of this subtitle; and
(2)
is required by the law of the state or country under which the foreign insurer or alien insurer is organized.
(b)
A policy of a domestic insurer that is issued for delivery in another state or country may contain a provision that is allowed or required by the laws of the other state or country.
Md. Code Ann., Ins. § 15-206 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–206LinkCopy Citation
(a)
A policy provision that is not subject to this subtitle may not make the policy or any part of the policy less favorable in any respect to the insured or beneficiary than the provisions of the policy that are subject to this subtitle.
(b)
A policy that is delivered or issued for delivery in the State in violation of this subtitle is valid but shall be construed as provided in this subtitle.
(c)
Whenever a policy provision that is subject to this subtitle conflicts with a provision of this subtitle, the rights, duties, and obligations of the insurer, insured, and beneficiary shall be governed by this subtitle.
Md. Code Ann., Ins. § 15-207 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–207LinkCopy Citation
Each policy of health insurance shall contain the following provision:
“Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No insurance producer has authority to change this policy or to waive any of its provisions.”
Md. Code Ann., Ins. § 15-208 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–208LinkCopy Citation
(a)
Except as provided in subsection (c) of this section, each policy of health insurance shall contain the following provision:
“Time limit on certain defenses: (1) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such two-year period.”
(2)
“No claim for loss incurred or disability (as defined in the policy) commencing after two years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.”
(b)
The first provision set forth in subsection (a) of this section does not:
(1)
affect a legal requirement for avoidance of a policy or denial of a claim during the initial two-year period after the issuance of the policy; or
(2)
limit the application of §§ 15-219 through 15-223 of this subtitle if there is a misstatement with respect to age, occupation, or other insurance.
(c)
(1)
This subsection applies only to a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:
(i)
until the insured is at least 50 years old; or
(ii)
if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.
(2)
A policy subject to this subsection may omit the first provision set forth in subsection (a) of this section and substitute the following provision under the caption “incontestable”:
“After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.”
(3)
In the provision set forth in paragraph (2) of this subsection, an insurer may omit the clause “excluding any period during which the insured is disabled”.
Md. Code Ann., Ins. § 15-209 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–209LinkCopy Citation
(a)
(1)
Subject to subsection (b) of this section, each policy of health insurance shall contain the following provision:
“Grace period: A grace period of ........ (insert a number not less than ‘7’ days for weekly premium policies, ‘10’ days for monthly premium policies and ‘31’ days for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period this policy shall continue in force.”
(2)
A policy shall provide a grace period of 31 days if the policy:
(i)
allows the policyholder to choose any one of two or more modes of premium payment by remitting an amount stated in the policy for that particular mode of payment; and
(ii)
does not require a formal request by the policyholder to change the mode of premium payment.
(b)
A policy in which the insurer reserves the right to refuse renewal shall state the following provision at the beginning of the provision set forth in subsection (a)(1) of this section:
“Unless not less than thirty days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted.”
Md. Code Ann., Ins. § 15-210 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–210LinkCopy Citation
(a)
Each policy of health insurance shall contain the following provision:
“Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurer or such insurance producer requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth (45th) day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty (60) days prior to the date of reinstatement.”
(b)
The last sentence of the provision set forth in subsection (a) of this section may be omitted from a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:
(1)
until the insured is at least 50 years old; or
(2)
if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.
Md. Code Ann., Ins. § 15-211 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–211LinkCopy Citation
(a)
Each policy of health insurance shall contain the following provision:
“Notice of claim: Written notice of claim must be given to the insurer within twenty (20) days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at .......... (insert the location of such office as the insurer may designate for the purpose), or to any authorized insurance producer of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.”
(b)
In a policy that provides a loss-of-time benefit that may be payable for at least 2 years, an insurer may insert the following provision between the first and second sentences of the provision set forth in subsection (a) of this section:
“Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall, at least once in every six (6) months after having given notice of the claim, give to the insurer notice of continuance of the disability, except in the event of legal incapacity. The period of six (6) months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured’s right to any indemnity which would otherwise have accrued during the period of six (6) months preceding the date on which such notice is actually given.”
Md. Code Ann., Ins. § 15-212 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–212LinkCopy Citation
Each policy of health insurance shall contain the following provision:
“Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.”
Md. Code Ann., Ins. § 15-213 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–213LinkCopy Citation
Except as provided in § 12–102(c) of this article, each policy of health insurance shall contain the following provision:
“Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety (90) days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required.”
Md. Code Ann., Ins. § 15-214 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–214LinkCopy Citation
(a)
Each policy of health insurance shall contain the following provision:
“Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment, will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ........ (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.”
(b)
A policy is considered to provide for periodic payment for loss only if the policy contains a specific statement to that effect.
Md. Code Ann., Ins. § 15-215 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–215LinkCopy Citation
(a)
Each policy of health insurance shall contain the following provision:
“Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured’s death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured.”
(b)
(1)
At the option of the insurer, a policy may include either or both of the provisions set forth in paragraphs (2) and (3) of this subsection with the provision set forth in subsection (a) of this section.
(2)
“If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is under eighteen years of age or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $ .......... (insert an amount which shall not exceed $1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment.”
(3)
“Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical or surgical services may, at the insurer’s option and unless the insured requests otherwise in writing not later than the time of filing proof of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.”
Md. Code Ann., Ins. § 15-216 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–216LinkCopy Citation
Each policy of health insurance shall contain the following provision:
“Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.”
Md. Code Ann., Ins. § 15-217 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–217LinkCopy Citation
Each policy of health insurance shall contain the following provision:
“Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three (3) years after the written proof of loss is required to be furnished.”
Md. Code Ann., Ins. § 15-218 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–218LinkCopy Citation
(a)
Subject to subsection (b) of this section, each policy of health insurance shall contain the following provision:
“Change of beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change a beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.”
(b)
An insurer may choose to omit from the provision set forth in subsection (a) of this section the clause:
“Unless the insured makes an irrevocable designation of beneficiary”.
Md. Code Ann., Ins. § 15-219 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–219LinkCopy Citation
A policy of health insurance may contain the following provision:
“Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence or the loss for which the insurer is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation.”
Md. Code Ann., Ins. § 15-220 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–220LinkCopy Citation
A policy of health insurance may contain the following provision:
“Misstatement of age: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.”
Md. Code Ann., Ins. § 15-221 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–221LinkCopy Citation
(a)
A policy of health insurance may contain the following provision:
“Other insurance in this insurer: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for ........ (insert type of coverage or coverages) in excess of $ ........ (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate.”
(b)
A policy of health insurance may substitute the following provision for the provision set forth in subsection (a) of this section:
“Insurance effective at any one time on the insured under a like policy or policies in this insurer is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurer will return all premiums paid for all other such policies.”
Md. Code Ann., Ins. § 15-222 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–222LinkCopy Citation
(a)
A policy of health insurance may contain the following provision:
“Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the ‘like amount’ of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.”
(b)
The phrase “-- Expense incurred benefits” shall be added to the caption of the provision set forth in subsection (a) of this section if the provision is included in a policy that contains the policy provision set forth in § 15-223 of this subtitle.
(c)
(1)
A benefit provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute, whether provided by a governmental unit or otherwise, shall be considered “other valid coverage” of which the insurer has had notice.
(2)
The insurer may include in the provision set forth in subsection (a) of this section a definition of “other valid coverage” if the definition:
(i)
is approved as to form by the Commissioner; and
(ii)
is limited to:
(1)
coverage provided by organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada;
(2)
coverage provided by hospital or medical service organizations; and
(3)
any other coverage that the Commissioner may approve for inclusion.
(3)
Unless defined otherwise, “other valid coverage” does not include:
(i)
group insurance or automobile medical payments insurance;
(ii)
coverage provided by hospital or medical service organizations; or
(iii)
coverage provided by union welfare plans or by employer or employee benefit organizations.
(4)
“Other valid coverage” may not include third party liability coverage.
Md. Code Ann., Ins. § 15-223 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–223LinkCopy Citation
(a)
A policy of health insurance may contain the following provision:
“Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined.”
(b)
The phrase “-- Other benefits” shall be added to the caption of the provision set forth in subsection (a) of this section if the provision is included in a policy that contains the policy provision set out in § 15-222 of this subtitle.
(c)
(1)
A benefit provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute, whether provided by a governmental unit or otherwise, shall be considered “other valid coverage” of which the insurer has had notice.
(2)
The insurer may include in the provision set forth in subsection (a) of this section a definition of “other valid coverage” if the definition:
(i)
is approved as to form by the Commissioner; and
(ii)
is limited to:
(1)
coverage provided by organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada; and
(2)
any other coverage the Commissioner may approve for inclusion.
(3)
Unless defined otherwise, “other valid coverage” does not include:
(i)
group insurance; or
(ii)
coverage provided by union welfare plans or by employer or employee benefit organizations.
(4)
“Other valid coverage” may not include third party liability coverage.
Md. Code Ann., Ins. § 15-224 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–224LinkCopy Citation
(a)
A policy of health insurance may contain the following provision:
“Relation of earnings to insurance: If the total monthly amount of loss-of-time benefits promised for the same loss under all valid loss-of-time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of $200 or the sum of the monthly benefits specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time.”
(b)
The policy provision set forth in subsection (a) of this section may be inserted only in a policy that the insured may continue in effect subject to its terms by the timely payment of premiums:
(1)
until the insured is at least 50 years old; or
(2)
if the policy is issued after the insured is 44 years old, for at least 5 years after its date of issue.
(c)
(1)
The insurer may include in the provision set forth in subsection (a) of this section a definition of “valid loss-of-time coverage” if the definition:
(i)
is approved as to form by the Commissioner;
(ii)
is limited to:
(1)
coverage provided by governmental units or organizations subject to regulation by insurance law or insurance authorities of this State, another state, or a province of Canada;
(2)
any other coverage that the Commissioner may approve for inclusion; or
(3)
a combination of these coverages.
(2)
Unless defined otherwise, “valid loss-of-time coverage” does not include:
(i)
coverage provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute; or
(ii)
coverage provided by union welfare plans or by employer or employee benefit organizations.
Md. Code Ann., Ins. § 15-225 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–225LinkCopy Citation
A policy of health insurance may contain the following provision:
“Unpaid premiums: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.”
Md. Code Ann., Ins. § 15-226 (2026)
Title 15. Health Insurance
Subtitle 2. Individual Health Insurance Policy Forms and Provisions
§ 15–226LinkCopy Citation
A policy of health insurance may contain the following provision:
“Conformity with state statutes: Any provision of this policy which, on its effective date is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.”