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<chapter num="43" heading="Medical Stop-Loss Insurance Disclosure" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter applies to carriers that sell medical stop-loss insurance to small employers in 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>“Carrier” means an insurer or nonprofit health service plan that sells medical stop loss insurance in Maryland.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Medical stop-loss insurance” has the meaning stated in Insurance Article, §15-129, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Medical stop-loss insurance disclosure form” means the form shown in Regulation .04 of this chapter.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Small employer” has the meaning stated in Insurance Article, §31-101, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Rules for Providing the Medical Stop-Loss Insurance Disclosure Form.">
    <paragraph num="A.">
      <text>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.</text>
    </paragraph>
    <paragraph num="B.">
      <text>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.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The medical stop-loss insurance disclosure form shall be printed in at least 12-point type.</text>
    </paragraph>
    <paragraph num="D.">
      <text>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:</text>
      <paragraph num="(1)">
        <text>Dollar limitations in the medical stop-loss insurance policy or contract, such as annual limitations;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Day or visit limits on the services covered under the medical stop-loss insurance policy or contract;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Limitations or exclusions that apply to benefits covered under the medical stop-loss insurance policy or contract, such as:</text>
        <paragraph num="(a)">
          <text>Pre-existing condition exclusions;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Exclusions or limitations for particular services, such as an exclusion or limitation for prescription drugs or mental health services;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Exclusions or limitations for particular medical conditions, such as AIDS;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Limitations or exclusions for non-medically necessary services; and</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Limitations or exclusions for experimental or investigational services; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>Different attachment points for any particular service, such as organ transplants.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Medical Stop-Loss Insurance Disclosure Form.">
    <text>The medical stop-loss insurance disclosure form shall read as follows:</text>
    <text>FORM AT END OF CHAPTER</text>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109(a)(1) and 15-129(f)(3), Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date:</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.04 adopted effective January 1, 2016 (42:23 Md. R. 1436)</annotation>
  </annotations>
</chapter>