Md. Code Regs. 31.12.02.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.12.02.03 - Submittals

A. Submittals of Forms to Commissioner.

(1) An HMO shall submit to the Commissioner for approval every form that it intends to use in Maryland.

(2) The Commissioner shall either approve or disapprove the form for use within 60 days of the receipt of the form in the Commissioner's office.

(3) An HMO may not use a form before the Commissioner's approval unless the Commissioner has not acted at the end of the 60-day period described in §A(2) of this regulation.

(4) The Commissioner may withdraw the Commissioner's prior approval or may disapprove a form previously permitted to be used if the Commissioner gives the HMO at least 30 days' notice before the effective date of the Commissioner's action disapproving the form.

B. Duplicate Forms Required For Nonelectronic Form Submissions.

(1) An HMO shall submit duplicate copies of each nonelectronic form the HMO intends to use in Maryland to the Commissioner for approval.

(2) If the Commissioner approves the nonelectronic form submitted by or on behalf of the HMO, the Commissioner shall:

(a) Retain one copy; and

(b) Return to the HMO one copy, with an appropriate notation indicating approval.

C. Each form submitted for approval shall be accompanied by:

(1) A current transmittal form developed by:

(a) The Maryland Insurance Administration; or

(b) The National Association of Insurance Commissioners (NAIC);

(2) A filing fee in accordance with Insurance Article, § 2-112, Annotated Code of Maryland;

(3) Except for electronic form filings, a self-addressed, stamped envelope; and

(4) A cover letter listing the forms submitted for approval by form number, with a brief description of each form filed for approval.

D. The HMO may not use a form disapproved by the Commissioner.

E. If a printed form has been disapproved, the HMO may resubmit the form with modifications made by imprinting, multigraph, mimeograph, multilith, electronic printer, or rubber stamp. The HMO may not resubmit a form with handwritten or typewritten changes, interlineations, or deletions.

F. Submission of Forms.

(1) Except as provided in §F(2) of this regulation, an HMO shall submit forms for approval with the Commissioner.

(2) A third party may submit a form for approval on behalf of an HMO, if the third party includes a written authorization from the HMO to make the form filing.

G. Representative Specimen Data. Except for applications filed for approval, an HMO shall complete each form filed for approval with representative specimen data.

H. Contracts with Insert Pages.

(1) An HMO may file for approval of a contract on an insert page basis, only if:

(a) Each insert page is identified by a unique form number appearing in the lower left corner of the insert page; and

(b) The HMO includes the following information in the filing submission:

(i) A description of how the various insert pages will be combined;

(ii) A listing of the insert pages that can be substituted for other specific insert pages; and

(iii) The filing fee required under Insurance Article, § 2-112, Annotated Code of Maryland, for each insert page with a unique form number.

(2) An HMO may not file for approval of insert pages for use with a previously approved contract, if the previously approved contract was not approved on an insert page basis.

(3) If an HMO files for approval of insert pages for a previously approved contract, the submission shall:

(a) Identify by form number and date of approval any insert pages that the new insert pages will replace; and

(b) Include a copy of the currently approved contract, unless the Commissioner waives the requirement or determines that a copy is not necessary to review the submission.

I. Contracts Comprised of Sections.

(1) An HMO may file for approval of a contract on a sectional basis, only if:

(a) Each section is identified by a unique form number appearing in the lower left corner of the first page of the section; and

(b) The HMO includes the following information in the filing submission:

(i) A description of how the various sections will be combined;

(ii) A listing of the sections that can be substituted for other specific sections; and

(iii) The filing fee required under Insurance Article, § 2-112, Annotated Code of Maryland, for each section with a unique form number.

(2) An HMO may not file for approval of sections for use with a previously approved contract, if the previously approved contract was not approved on a sectional basis.

(3) If an HMO files for approval of sections for a previously approved contract, the submission shall:

(a) Identify by form number and date of approval any sections that the new sections will replace; and

(b) Include a copy of the currently approved contract, unless the Commissioner waives the requirement or determines that a copy is not necessary to review the submission.

Md. Code Regs. 31.12.02.03