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<chapter num="19" heading="Filing of Forms Under File and Use Method" title_num="31" subtitle_num="04">
  <regulation prefix="Regulation" num=".01" heading="Applicability and Scope.">
    <text>This chapter applies to the submission of any form required to be filed under Insurance Article, §12-203(b), Annotated Code of Maryland.</text>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Accidental death policy” means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death of an insured.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Accidental death and dismemberment policy” means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death or dismemberment of an insured.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Administration” means the Maryland Insurance Administration.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Annuity” has the meaning defined in Insurance Article, §1-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Application.</text>
        <paragraph num="(a)">
          <text>“Application” means the form used to apply for insurance.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Application” includes:</text>
          <paragraph num="(i)">
            <text>Group applications and enrollment forms; and</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Individual applications.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(6)">
        <text>Blanket Health Insurance.</text>
        <paragraph num="(a)">
          <text>“Blanket health insurance” has the meaning stated in Insurance Article, §15-305, Annotated Code of Maryland.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Blanket health insurance” does not include a contract or policy for which a covered individual is required to complete an application.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(7)">
        <text>“Commissioner” means the Maryland Insurance Commissioner.</text>
      </paragraph>
      <paragraph num="(8)">
        <text>“Credit life insurance” has the meaning stated in Insurance Article, §13-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Employer Retrospective Premium Arrangement.</text>
        <paragraph num="(a)">
          <text>“Employer retrospective premium arrangement” means a rider to an employer group health insurance contract that provides that the employer may pay a negotiated reduced premium during the plan year, in accordance with a methodology approved by the Administration, with an adjustment at the end of the plan year based on the actual experience of the employer's group.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Employer retrospective premium arrangement” does not include any rider used with a small employer health benefit plan.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(10)">
        <text>Expense Incurred.</text>
        <paragraph num="(a)">
          <text>“Expense incurred” means the benefits payable under the health insurance contract are based on the medical expenses the insured incurs.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>For the purposes of this chapter, a health insurance contract that includes both expense incurred benefits and indemnity benefits shall be considered to be written on an expense incurred basis.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(11)">
        <text>“File and use method” means the method prescribed by the Commissioner which permits an insurer to file forms prescribed in Regulation .05 of this chapter and begin using the form at the earlier of:</text>
        <paragraph num="(a)">
          <text>30 days after the date the forms are received by the Commissioner, provided the forms are not disapproved by the Commissioner within this 30 day period; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>The date the insurer receives notice from the Commissioner that the filing has been accepted.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(12)">
        <text>“Final disposition” means approval, disapproval or withdrawal of a form submitted for approval.</text>
      </paragraph>
      <paragraph num="(13)">
        <text>Form.</text>
        <paragraph num="(a)">
          <text>“Form” means:</text>
          <paragraph num="(i)">
            <text>A policy;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>A certificate;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>A contract;</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>A rider;</text>
          </paragraph>
          <paragraph num="(v)">
            <text>An endorsement;</text>
          </paragraph>
          <paragraph num="(vi)">
            <text>An amendment; or</text>
          </paragraph>
          <paragraph num="(vii)">
            <text>An application.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>“Form” includes:</text>
          <paragraph num="(i)">
            <text>An insert page to a contract, if the insurer complies with the insert page filing requirements for contractsS on an insert page basis found in COMAR 31.04.17.04B; and</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>A section of a contract, if the insurer complies with the section filing requirements for contracts on a sectional basis found in COMAR 31.04.17.04C.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(14)">
        <text>“Health benefit plan” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(15)">
        <text>“Health insurance” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(16)">
        <text>“Indemnity” means the benefits payable under the health insurance contract are flat amounts that are not related to the expenses the insured incurs, such as a hospital indemnity contract that pays a flat fee for each day the insured is confined in a hospital regardless of the actual expenses the insured incurs during the hospital confinement.</text>
      </paragraph>
      <paragraph num="(17)">
        <text>“Insurer” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(18)">
        <text>“Life insurance” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(19)">
        <text>“Long term care insurance” has the meaning stated in Insurance Article, §18-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(20)">
        <text>“Medical stop-loss insurance” has the meaning stated in Insurance Article, §15-129(a), Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(21)">
        <text>“Medicare supplement policy” has the meaning stated in Insurance Article, §15-901, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(22)">
        <text>“Noncompliant” means a form is not in compliance with Maryland statutes and regulations.</text>
      </paragraph>
      <paragraph num="(23)">
        <text>“Prior approval method” means the method that insurers use to file forms with the Commissioner in which the forms may not be used in Maryland by the insurer until the forms are approved by the Commissioner.</text>
      </paragraph>
      <paragraph num="(24)">
        <text>“Small employer” has the meaning stated in Insurance Article, §31-101, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(25)">
        <text>“Wholesale life insurance” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Filing of Forms for Approval.">
    <text>Except as otherwise provided in this chapter, the filing of forms shall be in compliance with the requirements under:</text>
    <paragraph num="A.">
      <text>COMAR 31.04.17 for life and health insurance filings; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>COMAR 31.10.01 for health insurance filings.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Submission Requirements for File and Use Method.">
    <paragraph num="A.">
      <text>An insurer may request that a form filing be accepted under a file and use method.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The cover letter included with forms filed under the file and use method shall include the following:</text>
      <paragraph num="(1)">
        <text>A reference line that indicates that the forms are being filed under the file and use method;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>A list of the forms included in the submission; and</text>
      </paragraph>
      <paragraph num="(3)">
        <text>For each form listed in the cover letter required under §B(2) of this regulation, a cite to the authority to file the form under Regulation .05 of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The use of the file and use method shall be limited in accordance with the types of forms specified in Regulation .05 of this chapter.</text>
    </paragraph>
    <paragraph num="D.">
      <text>An insurer may not combine in the same submission:</text>
      <paragraph num="(1)">
        <text>Forms filed under the file and use method; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Forms filed under the prior approval method.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>A request under a file and use method shall include a signed certification from a responsible officer that, to the best of the officer's knowledge and belief, the forms comply with applicable statutes and regulations.</text>
    </paragraph>
    <paragraph num="F.">
      <text>A filing made under a file and use method shall be subject to the same filing fee requirements applicable to filings made under a prior approval method.</text>
    </paragraph>
    <paragraph num="G.">
      <text>An insurer may issue a form for delivery in Maryland that was filed under the file and use method at the earlier of the following dates:</text>
      <paragraph num="(1)">
        <text>30 days after the date the form has been received by the Commissioner, provided the Commissioner has not previously disapproved the filing; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The date the insurer receives written notice from the Commissioner that the filing has been accepted under the file and use method.</text>
      </paragraph>
    </paragraph>
    <paragraph num="H.">
      <text>An insurer may not use the file and use method before the insurer has had a certificate of authority to write the same type of coverage in Maryland for at least 12 months.</text>
    </paragraph>
    <paragraph num="I.">
      <text>An insurer may not use the file and use method to file a form in Maryland if:</text>
      <paragraph num="(1)">
        <text>The form has previously been disapproved by the Commissioner;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The form has been previously filed for approval with the Commissioner under the prior approval method and is still pending final disposition with the Commissioner; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>The Commissioner has decided that the form has been previously withdrawn by the insurer in accordance with COMAR 31.04.17.05.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Types of Forms Used on a File and Use Method.">
    <paragraph num="A.">
      <text>The forms listed in §B of this regulation are the only forms that may be used on a file and use basis.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The following life insurance, health insurance, and annuity forms may be filed under the file and use method:</text>
      <paragraph num="(1)">
        <text>Group life insurance policies and certificates, except for group credit life insurance policies and certificates;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Endorsements, amendments, and riders to be used with group life insurance policies and certificates, except for endorsements, amendments, and riders to be used with group credit life insurance policies and certificates;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Wholesale life insurance policies;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Endorsements, amendments, and riders to be used with wholesale life insurance policies;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Accidental death benefit riders to be used with individual life insurance policies;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Waiver of premium riders to be used with individual life insurance policies;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Accidental death and dismemberment riders to be used with individual life insurance policies;</text>
      </paragraph>
      <paragraph num="(8)">
        <text>Riders to be used with individual life insurance policies that provide coverage to the spouse or dependent children of the insured;</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Guaranteed insurability option riders to be used with individual life insurance policies;</text>
      </paragraph>
      <paragraph num="(10)">
        <text>Group annuity contracts and certificates, including variable and nonvariable group annuity contracts and certificates;</text>
      </paragraph>
      <paragraph num="(11)">
        <text>Endorsements, amendments, and riders to be used with group annuity contracts and certificates;</text>
      </paragraph>
      <paragraph num="(12)">
        <text>Individual retirement account (IRA) endorsements to be used with individual fixed annuity contracts or with individual variable annuity contracts;</text>
      </paragraph>
      <paragraph num="(13)">
        <text>Tax sheltered annuity (TSA) endorsements to be used with:</text>
        <paragraph num="(a)">
          <text>Individual fixed annuity contracts; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Individual variable annuity contracts;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(14)">
        <text>Medical stop-loss insurance;</text>
      </paragraph>
      <paragraph num="(15)">
        <text>Group accidental death policies and certificates;</text>
      </paragraph>
      <paragraph num="(16)">
        <text>Group accidental death and dismemberment policies and certificates;</text>
      </paragraph>
      <paragraph num="(17)">
        <text>Group travel health insurance policies and certificates, except for the following:</text>
        <paragraph num="(a)">
          <text>Any form that includes lost baggage benefits;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Any form that includes a trip cancellation benefit that is payable for a reason other than the illness or death of:</text>
          <paragraph num="(i)">
            <text>The insured;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>A member of the insured's family; or</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>One or more of the insured's travel companions; or</text>
          </paragraph>
        </paragraph>
        <paragraph num="(c)">
          <text>Any form that contains any other property or casualty type benefit not included in §B(17)(a) and (b) of this regulation;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(18)">
        <text>Group health insurance policies and certificates that:</text>
        <paragraph num="(a)">
          <text>Limit coverage to losses due to accident; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Do not pay benefits on an expense-incurred basis;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(19)">
        <text>Employer retrospective premium arrangements;</text>
      </paragraph>
      <paragraph num="(20)">
        <text>Blanket health insurance policies that limit benefits to accidental death benefits;</text>
      </paragraph>
      <paragraph num="(21)">
        <text>Blanket health insurance policies that limit benefits to accidental death and dismemberment benefits;</text>
      </paragraph>
      <paragraph num="(22)">
        <text>Blanket health insurance policies that limit benefits to travel benefits;</text>
      </paragraph>
      <paragraph num="(23)">
        <text>Blanket health insurance policies that:</text>
        <paragraph num="(a)">
          <text>Limit coverage to losses due to accident; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Do not pay benefits on an expense-incurred basis; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(24)">
        <text>Applications, except applications for:</text>
        <paragraph num="(a)">
          <text>Medicare supplement policies;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Long-term care insurance;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Individual health benefit plans; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Small employer health benefit plans.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Use of Noncompliant Forms.">
    <paragraph num="A.">
      <text>If an insurer uses a form which becomes effective under a file and use method and the form is found by the Commissioner to be noncompliant, the Commissioner may:</text>
      <paragraph num="(1)">
        <text>Disapprove the form by:</text>
        <paragraph num="(a)">
          <text>Giving notice of the disapproval;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Showing cause for the disapproval; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Stating the effective date of the disapproval in the notice; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Impose a penalty as provided under Insurance Article, §4-113, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The Commissioner may remove file and use authority from an insurer upon a finding that the insurer has made inappropriate or noncompliant filings under this method with such frequency as to constitute a business practice.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109 and 12-203(d)(2), Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: July 17, 2006 (33:14 Md. R. 1165)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective June 20, 2016 (43:12 Md. R. 668)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05B amended effective June 20, 2016 (43:12 Md. R. 668)</annotation>
  </annotations>
</chapter>