<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 31.11.10.06" title_num="31" subtitle_num="11" chapter_num="10" heading="Limitations and Exclusions.">
  <paragraph num="A.">
    <text>Crime.</text>
    <paragraph num="(1)">
      <text>Except as described in §A(3) of this regulation, a group health insurance contract or blanket 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>A group health insurance contract or blanket 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 group disability benefit or a group accidental death and dismemberment benefit:</text>
      <paragraph num="(a)">
        <text>May include an 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 contain an exclusion or limitation which 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 described in §B(2) of this regulation, a group health insurance contract or blanket 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 group disability benefit or a group accidental death and dismemberment benefit:</text>
      <paragraph num="(a)">
        <text>May include an exclusion or limitation for loss to which a contributing cause was the insured being engaged in an illegal occupation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>May not contain an exclusion or limitation which 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 described in §C(2) of this regulation, a group health insurance contract or blanket 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 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 group disability benefit or a group accidental death and dismemberment benefit:</text>
      <paragraph num="(a)">
        <text>May include an exclusion or limitation for loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>May not contain an exclusion or limitation regarding the use of alcohol or drugs which 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 Conditions.</text>
    <paragraph num="(1)">
      <text>Each group health insurance contract or blanket health insurance contract shall contain a provision specifying the additional exclusions or limitations, if any, applicable under the contract with respect to a disease or physical condition of an individual, not otherwise excluded from the individual's coverage by name or specific description effective on the date of the individual's loss, that existed before the effective date of the individual's coverage under the contract.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The exclusion described in §D(1) of this regulation may apply only to a disease or physical condition for which medical advice or treatment was received by the individual during the 12 months before the effective date of the individual's coverage.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The exclusion described in §D(1) of this regulation does not apply to loss incurred or disability beginning after the earlier of:</text>
      <paragraph num="(a)">
        <text>The end of a continuous period of 12 months beginning on or after the effective date of the individual's coverage during all of which the individual has received no medical advice or treatment in connection with the disease or physical condition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The end of the 1-year period beginning on the effective date of the individual's coverage, if the individual's application or enrollment form does not include health questions; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The end of the 2-year period beginning on the effective date of the individual's coverage, if the individual's application or enrollment form includes health questions.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>If a group health insurance contract or blanket 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>
  </paragraph>
</regulation>