Ch. 294

1997 LAWS OF MARYLAND

(R) "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.

(S) "WAITING PERIOD" MEANS THE PERIOD OF TIME THAT MUST PASS
BEFORE AN INDIVIDUAL IS ELIGIBLE TO BE COVERED FOR BENEFITS UNDER THE
TERMS OF A GROUP HEALTH BENEFIT PLAN.

(T) (1) "WEIGHTED AVERAGE" MEANS THE AVERAGE ACTUARIAL VALUE
OF THE BENEFITS PROVIDED BY:

(I) ALL THE HEALTH INSURANCE COVERAGES ISSUED BY THE
CARRIER IN THIS STATE IN THE INDIVIDUAL MARKET DURING THE PREVIOUS
CALENDAR YEAR, WEIGHTED BY ENROLLMENT FOR THE DIFFERENT COVERAGES;
OR

(II) ALL THE HEALTH INSURANCE COVERAGES ISSUED BY ALL
CARRIERS IN THIS STATE IN THE INDIVIDUAL MARKET, IF THE DATA ARE
AVAILABLE, DURING THE PREVIOUS CALENDAR YEAR, WEIGHTED BY ENROLLMENT
FOR THE DIFFERENT COVERAGES.

(2) "WEIGHTED AVERAGE" DOES NOT INCLUDE COVERAGES ISSUED
UNDER THIS SUBTITLE

753.

(A) THIS SUBTITLE APPLIES TO ALL CARRIERS THAT OFFER HEALTH BENEFIT
PLANS TO INDIVIDUALS IN THE STATE

(B) THIS SUBTITLE DOES NOT APPLY TO A CARRIER THAT OFFERS ONLY
CONVERSION POLICIES AS REQUIRED BY LAW.

(C) THIS SUBTITLE DOES NOT APPLY TO A CARRIER THAT OFFERS HEALTH
INSURANCE COVERAGE ONLY IN CONNECTION WITH GROUP HEALTH PLANS OR
THROUGH ONE OR MORE BONA FIDE ASSOCIATIONS, OR BOTH.

754.

IN ADDITION TO ANY OTHER REQUIREMENTS UNDER THIS ARTICLE, A
CARRIER THAT OFFERS INDIVIDUAL HEALTH BENEFIT PLANS IN THIS STATE SHALL:

(1) HAVE DEMONSTRATED THE CAPACITY TO ADMINISTER THE
INDIVIDUAL HEALTH BENEFIT PLANS, INCLUDING ADEQUATE NUMBERS AND TYPES
OF ADMINISTRATIVE STAFF;

(2) HAVE A SATISFACTORY GRIEVANCE PROCEDURE AND ABILITY TO
RESPOND TO CALLS, QUESTIONS, AND COMPLAINTS FROM ENROLLEES OR
INSUREDS; AND

(3) DESIGN POLICIES TO HELP ENSURE THAT ENROLLEES OR INSUREDS
HAVE ADEQUATE ACCESS TO PROVIDERS OF HEALTH CARE.

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