Ch. 9

1993 LAWS OF MARYLAND

(V) (III) A REQUEST FOR ENROLLMENT IS MADE WITHIN 30 DAYS
AFTER THE ELIGIBLE EMPLOYEE'S MARRIAGE OR THE BIRTH OR ADOPTION OF A
CHILD.

(I) (J) (1) "MANDATED BENEFIT" MEANS A STATUTE IN THIS ARTICLE OR
IN THE HEALTH - GENERAL ARTICLE OF THE CODE THAT WOULD REQUIRE A
PARTICULAR HEALTH CARE SERVICE, BENEFIT, COVERAGE, OR REIMBURSEMENT
FOR COVERED HEALTH CARE SERVICES TO BE PROVIDED OR OFFERED IN A
HEALTH BENEFIT PLAN ISSUED OR DELIVERED IN THE STATE BY A CARRIER.

(2) "MANDATED BENEFIT" INCLUDES A STATUTE THAT WOULD
REQUIRE A HEALTH BENEFIT PLAN THAT PROVIDES REIMBURSEMENT FOR ANY
SERVICE WITHIN THE SCOPE OF PRACTICE OF A HEALTH CARE PROVIDER LICENSED
UNDER THE HEALTH OCCUPATIONS ARTICLE TO PROVIDE REIMBURSEMENT FOR
ALL SERVICES PROVIDED BY THAT PROVIDER A SERVICE TO PROVIDE
REIMBURSEMENT FOR THAT SERVICE WHEN PERFORMED BY ANY HEALTH CARE
PROVIDER WHO IS LICENSED UNDER THE HEALTH - GENERAL ARTICLE AND WHOSE
SCOPE OF PRACTICE INCLUDES THAT SERVICE.

(K) "POOL" MEANS THE MARYLAND SMALL EMPLOYER HEALTH REINSURANCE
POOL ESTABLISHED UNDER THIS SUBTITLE.

(J) (L) "PREEXISTING CONDITION" MEANS:

(1) A CONDITION THAT WOULD CAUSE AN ORDINARILY PRUDENT
PERSON TO SEEK MEDICAL ADVICE, DIAGNOSIS, CARE, OR TREATMENT; OR

(1) A CONDITION EXISTING DURING A SPECIFIED PERIOD IMMEDIATELY
PRECEDING THE EFFECTIVE DATE OF COVERAGE THAT WOULD HAVE CAUSED AN
ORDINARILY PRUDENT PERSON TO SEEK MEDICAL ADVICE, DIAGNOSIS, CARE, OR
TREATMENT; OR

(2) A CONDITION FOR WHICH MEDICAL ADVICE, DIAGNOSIS, CARE, OR
TREATMENT WAS RECOMMENDED OR RECEIVED DURING A SPECIFIED PERIOD
IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF THIS COVERAGE.

(K) (M) "PREEXISTING CONDITION PROVISION" MEANS A PROVISION IN A
HEALTH BENEFIT PLAN THAT DENIES, EXCLUDES, OR LIMITS BENEFITS FOR AN
ENROLLEE FOR EXPENSES OR SERVICES RELATED TO A PREEXISTING CONDITION.

(N) "REINSURING CARRIER" MEANS A CARRIER PARTICIPATING IN THE POOL.

(O) "RISK-ASSUMING CARRIER" MEANS A CARRIER NOT PARTICIPATING IN THE
POOL.

(L) (P) (1) "SMALL EMPLOYER" MEANS ANY PERSON, SOLE PROPRIETOR,
FIRM, CORPORATION, PARTNERSHIP, OR ASSOCIATION ACTIVELY ENGAGED IN
BUSINESS AND, ON AT LEAST 50 PERCENT OF ITS WORKING DAYS DURING THE
PRECEDING CALENDAR YEAR, EMPLOYED AT LEAST TWO BUT NO MORE THAN 50
ELIGIBLE EMPLOYEES, THE MAJORITY OF WHOM ARE EMPLOYED WITHIN THE

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