(a) Except as provided in subsection (b)(1) of this section, an insurance contract or annuity contract shall contain the standard provisions required under this article.
Waivers by Commissioner
(b)(1) The Commissioner may waive the required use of a provision in an insurance policy or contract form if the Commissioner:
(i) finds that the provision is unnecessary to protect the insured or is inconsistent with the purposes of the policy; and
(ii) approves the policy.
(2) A required standard provision may not be waived by agreement between an insurer and another person.
Minimum period of time to submit claim for service
(c)(1)(i) In this subsection the following words have the meanings indicated.
(ii) “Carrier” means:
1. an insurer authorized to sell health insurance;
2. a nonprofit health service plan;
3. a health maintenance organization; or
4. any other entity providing a plan of health insurance, health benefits, or health services authorized under this article or the Affordable Care Act.
(iii) “Enrollee” means an individual entitled to benefits from a carrier's health benefit plan.
(iv) “Health benefit plan” has the meaning stated in § 15-1301 of this article.
(2) Each health benefit plan issued by a carrier shall include provisions that:
(i) permit enrollees a minimum of 1 year after the date of service to submit a claim for the service;
(ii) provide that:
1. an enrollee's legal incapacity shall suspend the time to submit a claim; and
2. the suspension period ends when legal capacity is regained; and
(iii) provide that the failure to submit a claim within 1 year after the date of service does not invalidate or reduce the amount of the claim if:
1. it was not reasonably possible to submit the claim within 1 year after the date of service; and
2. the claim is submitted within 2 years after the date of service.
Substitute provisions
(d) The Commissioner may approve a substitute provision in an insurance policy or annuity contract if the provision is not less favorable than the required provision to the insured, annuitant, or beneficiary.
Substantially similar provisions used by foreign or alien insurers
(e) Instead of a provision required by this article, a foreign insurer or alien insurer may use a substantially similar provision required by the law of the foreign insurer's or alien insurer's domicile if the substantially similar provision does not conflict with the law of this State.
Inconsistent provisions prohibited
(f) A policy or contract may not contain a provision that is inconsistent with a standard provision used or required to be used.
Credits
Added by Acts 1995, c. 36, § 1, eff. Oct. 1, 1997. Amended by Acts 2016, c. 445, § 1, eff. Jan. 1, 2017.
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
