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<chapter num="28" heading="Individual Health Insurance Contracts — Standard Provisions and Exclusions" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter is applicable to each individual health insurance contract issued or delivered in Maryland on or after the effective date of this chapter.</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>“Coverage period” means the interval of time the individual health insurance contract provides protection to the insured, in exchange for the payment of a particular premium.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Individual health insurance contract” means a health insurance contract issued by an insurer to a policyholder that provides health insurance coverage for permissible individuals as described in Insurance Article, §15-201(c), Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Insured” means a person covered under an individual health insurance contract.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Limitations and Exclusions.">
    <paragraph num="A.">
      <text>Crime.</text>
      <paragraph num="(1)">
        <text>Except as provided in §A(3) of this regulation, an individual health insurance contract may not include a limitation or exclusion for loss to which a contributing cause was the insured's commission of or attempt to commit a crime.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>An individual health insurance contract may not include a limitation or exclusion for loss for which a contributing cause was the commission of or the attempt to commit a crime by an individual other than the insured.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>A disability benefit or an accidental death and dismemberment benefit in an individual health insurance contract:</text>
        <paragraph num="(a)">
          <text>May be subject to exclusion or limitation for loss to which a contributing cause was the insured's commission of or attempt to commit a felony; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>May not be subject to an exclusion or limitation regarding the commission of or attempt to commit a crime that is more restrictive to the insured than the exclusion or limitation set forth in §A(3)(a) of this regulation.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Illegal Occupation.</text>
      <paragraph num="(1)">
        <text>Except as provided in §B(2) of this regulation, an individual health insurance contract may not include a limitation or exclusion for loss to which a contributing cause was the insured's being engaged in an illegal occupation.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>A disability benefit or an accidental death and dismemberment benefit in an individual health insurance contract:</text>
        <paragraph num="(a)">
          <text>May be subject to an exclusion or limitation for loss to which a contributing cause was the insured's being engaged in an illegal occupation; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>May not be subject to an exclusion or limitation regarding an illegal occupation that is more restrictive to the insured than the exclusion or limitation set forth in §B(2)(a) of this regulation.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Intoxicants and Narcotics.</text>
      <paragraph num="(1)">
        <text>Except as provided in §C(2) of this regulation, an individual health insurance contract may not include a limitation or exclusion for loss:</text>
        <paragraph num="(a)">
          <text>Sustained or contracted in consequence of the insured's being intoxicated or under the influence of any drug;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Due to the use of alcohol;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Due to the use of drugs or narcotics; or</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Due to alcoholism or drug addiction.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>A disability benefit or an accidental death and dismemberment benefit in an individual health insurance contract:</text>
        <paragraph num="(a)">
          <text>May be subject to an exclusion or limitation for loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>May not be subject to an exclusion or limitation regarding the use of alcohol or drugs that is more restrictive to the insured than the exclusion or limitation set forth in §C(2)(a) of this regulation.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Preexisting Condition Limitation. If an individual health insurance contract contains a preexisting condition limitation or exclusion, the limitation or exclusion may not apply to a condition that the applicant revealed in the application for the contract, unless the condition is excluded by means of a signed waiver rider attached to the contract.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Arbitration.">
    <text>If an insurer includes an arbitration provision in an individual health insurance contract, the arbitration provision may not require the insured to use arbitration to settle disputes with the insurer.</text>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Premium Due Date.">
    <paragraph num="A.">
      <text>Each individual health insurance contract shall specify the premium due date.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The premium due date shall be no earlier than the date the coverage period begins.</text>
    </paragraph>
    <paragraph num="C.">
      <text>An insurer may offer each individual policyholder the option to pay the premium through an electronic payment.</text>
    </paragraph>
    <paragraph num="D.">
      <text>If the individual policyholder elects an electronic payment, the insurer may not debit or charge the amount of the premium due prior to the premium due date, except as authorized by the individual policyholder.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109, 12-203(g), and 12-205(b)(4), Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date:</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.04 adopted as an emergency provision effective January 1, 2002 (28:26 Md. R. 2270); adopted permanently effective June 10, 2002 (29:11 Md. R. 891)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective October 18, 2010 (37:21 Md. R. 1438)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03A amended as an emergency provision effective May 9, 2003 (30:11 Md. R. 733); amended permanently effective October 27, 2003 (30:21 Md. R. 1531)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05 adopted effective October 18, 2010 (37:21 Md. R. 1438)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05B amended effective April 22, 2019 (46:8 Md. R. 402)</annotation>
  </annotations>
</chapter>