S.B. 843

VETOES

(2)      "CARRIER" HAS THE MEANING STATED IN § 15-1301 OF THIS TITLE

(3)      "POLICY OR CERTIFICATE" MEANS ANY GROUP OR BLANKET
HEALTH INSURANCE CONTRACT OR POLICY THAT IS ISSUED OR DELIVERED IN THE
STATE BY AN INSURER OR NONPROFIT HEALTH SERVICE PLAN THAT PROVIDES
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS ON AN EXPENSE-INCURRED BASIS.

(4)      "PREEXISTING CONDITION PROVISION" HAS THE MEANING STATED
IN § 15-1301 OF THIS TITLE.

(5)      "LATE ENROLLEE" HAS THE MEANING STATED IN § 15-1401 OF THIS
TITLE.

(B)     THIS SECTION DOES NOT APPLY TO A POLICY OR CERTIFICATE ISSUED TO
A SMALL EMPLOYER IN ACCORDANCE WITH SUBTITLE 12 OF THIS TITLE, OR TO AN
INDIVIDUAL IN ACCORDANCE WITH SUBTITLE 13 OF THIS TITLE

(C)     EXCEPT AS OTHERWISE PROVIDED IN SUBSECTION (D) OF THIS SECTION,
A CARRIER MAY IMPOSE A PREEXISTING CONDITION PROVISION ONLY IF IT:

(1)      RELATES TO A CONDITION, REGARDLESS OF THE CAUSE OF THE
CONDITION, FOR WHICH MEDICAL ADVICE, DIAGNOSIS, CARE, OR TREATMENT WAS
RECOMMENDED OR RECEIVED WITHIN THE 6-MONTH PERIOD ENDING ON THE
ENROLLMENT DATE;

(2)      EXTENDS FOR A PERIOD OF NOT MORE THAN 12 MONTHS AFTER
THE ENROLLMENT DATE OR 18 MONTHS IN THE CASE OF A LATE ENROLLEE; AND

(3)      IS REDUCED BY THE AGGREGATE OF THE PERIODS OF CREDITABLE
COVERAGE, AS DEFINED IN SUBTITLE 14 OF THIS TITLE.

(D)     (1) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION, A CARRIER MAY
NOT IMPOSE ANY PREEXISTING CONDITION PROVISION ON AN INDIVIDUAL WHO, AS
OF THE LAST DAY OF THE 30-DAY PERIOD BEGINNING WITH THE DATE OF BIRTH, IS
COVERED UNDER CREDITABLE COVERAGE.

(2)      SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION, A CARRIER MAY
NOT IMPOSE ANY PREEXISTING CONDITION PROVISIONS ON A CHILD WHO:

(I)       IS ADOPTED OR PLACED FOR ADOPTION BEFORE ATTAINING
18 YEARS OF AGE; AND

(II)     AS OF THE LAST DAY OF THE 30-DAY PERIOD BEGINNING ON
THE DATE OF ADOPTION OR PLACEMENT FOR ADOPTION, IS COVERED UNDER
CREDITABLE COVERAGE

(3)      A CARRIER MAY NOT IMPOSE ANY PREEXISTING CONDITION
PROVISIONS RELATING TO PREGNANCY.

(4)      PARAGRAPHS (1) AND (2) OF THIS SUBSECTION DO NOT APPLY TO AN
INDIVIDUAL AFTER THE END OF THE FIRST 63-DAY PERIOD DURING ALL OF WHICH
THE INDIVIDUAL WAS NOT COVERED UNDER ANY CREDITABLE COVERAGE

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