<?xml version='1.0' encoding='utf-8'?>
<chapter num="02" heading="Medically Uninsurable Individual Based on a Medical or Health Condition" title_num="31" subtitle_num="17">
  <regulation prefix="Regulation" num=".01" heading="Purpose.">
    <text>This chapter establishes the criteria for individuals who have certain medical or health conditions to qualify for coverage under the Maryland Health Insurance Plan.</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:</text>
        <paragraph num="(a)">
          <text>An authorized insurer that provides health insurance in the State;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A nonprofit health service plan that is licensed to operate in the State; or</text>
        </paragraph>
        <paragraph num="(c)">
          <text>A health maintenance organization that is licensed to operate in the State.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Medical or health condition” means any of the following:</text>
        <paragraph num="(a)">
          <text>Acquired immunodeficiency syndrome (AIDS);</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Addison's disease;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease);</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Alzheimer's disease;</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Angina pectoris;</text>
        </paragraph>
        <paragraph num="(f)">
          <text>Ankylosing Spondylitis;</text>
        </paragraph>
        <paragraph num="(g)">
          <text>Anorexia;</text>
        </paragraph>
        <paragraph num="(h)">
          <text>Aplastic anemia;</text>
        </paragraph>
        <paragraph num="(i)">
          <text>Ascites;</text>
        </paragraph>
        <paragraph num="(j)">
          <text>Banti's disease;</text>
        </paragraph>
        <paragraph num="(k)">
          <text>Behavioral health in-patient treatment within the last 12 months;</text>
        </paragraph>
        <paragraph num="(l)">
          <text>Bipolar disorder;</text>
        </paragraph>
        <paragraph num="(m)">
          <text>Bulimia;</text>
        </paragraph>
        <paragraph num="(n)">
          <text>Cancer treated or diagnosed within the last 5 years, except skin cancer;</text>
        </paragraph>
        <paragraph num="(o)">
          <text>Cardiomyopathy;</text>
        </paragraph>
        <paragraph num="(p)">
          <text>Chemical dependency;</text>
        </paragraph>
        <paragraph num="(q)">
          <text>Chronic obstructive pulmonary disease;</text>
        </paragraph>
        <paragraph num="(r)">
          <text>Cirrhosis of the liver;</text>
        </paragraph>
        <paragraph num="(s)">
          <text>Coronary artery disease;</text>
        </paragraph>
        <paragraph num="(t)">
          <text>Coronary heart failure;</text>
        </paragraph>
        <paragraph num="(u)">
          <text>Coronary insufficiency;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Coronary occlusion;</text>
        </paragraph>
        <paragraph num="(w)">
          <text>Creutzfeldt-Jakob disease;</text>
        </paragraph>
        <paragraph num="(x)">
          <text>Crohn's disease;</text>
        </paragraph>
        <paragraph num="(y)">
          <text>Cystic fibrosis;</text>
        </paragraph>
        <paragraph num="(z)">
          <text>Dementia;</text>
        </paragraph>
        <paragraph num="(aa)">
          <text>Type I or II diabetes;</text>
        </paragraph>
        <paragraph num="(bb)">
          <text>Disorders from organic brain damage;</text>
        </paragraph>
        <paragraph num="(cc)">
          <text>Emphysema;</text>
        </paragraph>
        <paragraph num="(dd)">
          <text>Esophageal varices;</text>
        </paragraph>
        <paragraph num="(ee)">
          <text>Friederich's ataxia;</text>
        </paragraph>
        <paragraph num="(ff)">
          <text>Guillain-Barré syndrome;</text>
        </paragraph>
        <paragraph num="(gg)">
          <text>Hemochromatosis;</text>
        </paragraph>
        <paragraph num="(hh)">
          <text>Hemophilia;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Hepatitis B or C;</text>
        </paragraph>
        <paragraph num="(jj)">
          <text>Hodgkin's disease;</text>
        </paragraph>
        <paragraph num="(kk)">
          <text>Human immunodeficiency virus (HIV);</text>
        </paragraph>
        <paragraph num="(ll)">
          <text>Huntington's chorea;</text>
        </paragraph>
        <paragraph num="(mm)">
          <text>Hydrocephalus;</text>
        </paragraph>
        <paragraph num="(nn)">
          <text>Kidney disease requiring dialysis;</text>
        </paragraph>
        <paragraph num="(oo)">
          <text>Leukemia;</text>
        </paragraph>
        <paragraph num="(pp)">
          <text>Lupus erythematosus disseminate;</text>
        </paragraph>
        <paragraph num="(qq)">
          <text>Major organ transplant recipient;</text>
        </paragraph>
        <paragraph num="(rr)">
          <text>Melanoma;</text>
        </paragraph>
        <paragraph num="(ss)">
          <text>Multiple myeloma;</text>
        </paragraph>
        <paragraph num="(tt)">
          <text>Multiple or disseminated sclerosis;</text>
        </paragraph>
        <paragraph num="(uu)">
          <text>Muscular dystrophy;</text>
        </paragraph>
        <paragraph num="(vv)">
          <text>Myasthenia gravis;</text>
        </paragraph>
        <paragraph num="(ww)">
          <text>Myotonia;</text>
        </paragraph>
        <paragraph num="(xx)">
          <text>Non-Hodgkin's lymphoma;</text>
        </paragraph>
        <paragraph num="(yy)">
          <text>Palsy;</text>
        </paragraph>
        <paragraph num="(zz)">
          <text>Paraplegia;</text>
        </paragraph>
        <paragraph num="(aaa)">
          <text>Parkinson's disease;</text>
        </paragraph>
        <paragraph num="(bbb)">
          <text>Pick's disease;</text>
        </paragraph>
        <paragraph num="(ccc)">
          <text>Porphyria;</text>
        </paragraph>
        <paragraph num="(ddd)">
          <text>Pregnancy;</text>
        </paragraph>
        <paragraph num="(eee)">
          <text>Presence of a pacemaker;</text>
        </paragraph>
        <paragraph num="(fff)">
          <text>Psychotic disorder;</text>
        </paragraph>
        <paragraph num="(ggg)">
          <text>Quadriplegia;</text>
        </paragraph>
        <paragraph num="(hhh)">
          <text>Rheumatoid arthritis;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Scleroderma;</text>
        </paragraph>
        <paragraph num="(jjj)">
          <text>Sickle cell disease;</text>
        </paragraph>
        <paragraph num="(kkk)">
          <text>Cerebrovascular accident (stroke);</text>
        </paragraph>
        <paragraph num="(lll)">
          <text>Syringomyelia;</text>
        </paragraph>
        <paragraph num="(mmm)">
          <text>Tay-Sachs disease;</text>
        </paragraph>
        <paragraph num="(nnn)">
          <text>Ulcerative colitis;</text>
        </paragraph>
        <paragraph num="(ooo)">
          <text>Wernicke-Kosakoff syndrome;</text>
        </paragraph>
        <paragraph num="(ppp)">
          <text>Wilm's tumor; or</text>
        </paragraph>
        <paragraph num="(qqq)">
          <text>Wilson's disease.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>Medically Uninsurable Individual.</text>
        <paragraph num="(a)">
          <text>“Medically uninsurable individual” means an individual who is a resident of the State and who:</text>
          <paragraph num="(i)">
            <text>Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual, except at a rate that exceeds the Plan rate;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>Is an eligible individual under Insurance Article, §15-1301, Annotated Code of Maryland;</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>Has a history of or suffers from a medical or health condition as defined in §B(2) of this regulation; or</text>
          </paragraph>
          <paragraph num="(v)">
            <text>Is a dependent of an individual who is eligible for coverage under this subsection.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>“Medically uninsurable individual” does not include an individual who is eligible for coverage under:</text>
          <paragraph num="(i)">
            <text>The federal Medicare program;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>The Maryland Medical Assistance Program;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>The Maryland Children's Health Program; or</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>An employer-sponsored group health insurance plan that includes benefits comparable to Plan benefits.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>“Plan” means the Maryland Health Insurance Plan.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Proof of a Medical or Health Condition.">
    <paragraph num="A.">
      <text>The Plan shall consider that an individual meets the requirements of Regulation .02B(3)(a)(iv) of this chapter if the individual supplies documentation from a licensed physician that states that the individual has a history of or suffers from a medical or health condition.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The documentation required in §A of this regulation shall specifically list one of the medical or health conditions in Regulation .02B(2) of this chapter.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The documentation required in §A of this regulation may be a letter from a licensed physician.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§14-501(h)(1)(iv) and 14-503(k), Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date:</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.03 adopted as an emergency provision effective February 6, 2003 (30:5 Md. R. 365); adopted permanently effective August 4, 2003 (30:15 Md. R. 993)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective January 30, 2006 (33:2 Md. R. 85); May 5, 2008 (35:9 Md. R. 900); December 29, 2008 (35:26 Md. R. 2251)</annotation>
  </annotations>
</chapter>