PARRIS N. GLENDENING, Governor

Ch. 294

PAYS THE PREMIUM AND IS NOT BEING COVERED UNDER THE POLICY OR
CONTRACT UNDER EITHER FEDERAL OR STATE CONTINUATION OF BENEFITS
PROVISIONS.

(2) "INDIVIDUAL HEALTH BENEFIT PLAN" DOES NOT INCLUDE
SHORT-TERM LIMITED DURATION INSURANCE

(P) "LOW LEVEL POLICY FORM" MEANS A POLICY OR PLAN UNDER WHICH
THE ACTUARIAL VALUE OF THE BENEFIT UNDER THE COVERAGE IS AT LEAST 85%
BUT NOT GREATER THAN 100% OF THE WEIGHTED AVERAGE.

(Q) "PREEXISTING CONDITION" MEANS:

(1) A CONDITION EXISTING DURING A SPECIFIED PERIOD
IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF COURAGE 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 A CONDITION
THAT WAS PRESENT BEFORE THE DATE OF ENROLLMENT FOR COVERAGE
WHETHER OR NOT ANY MEDICAL ADVICE, DIAGNOSIS. CARE OR TREATMENT WAS
RECOMMENDED OR RECEIVED BEFORE THAT DATE.

(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

15-1302.

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

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