Md. Code Regs. 31.12.02.07

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

Section 31.12.02.07 - Application

A. An application form shall stipulate the plan and any optional benefits being applied for.

B. Permissible Look-Back Periods.

(1) Except as provided in §B(2) of this regulation, an application form may not ask any question relative to any previously existing injury, sickness, or condition which has not required medical care or advice during the:

(a) 7-year period immediately preceding the date of the application if the application is made for coverage under a group contract; or

(b) 5-year period immediately preceding the date of the application, if the application is made for coverage under an individual contract.

(2) An application may inquire about a dismemberment or other current impairment, the cause of which may have occurred before the time periods permitted by §B(1) of this regulation.

C. If an application contains questions regarding past or present health conditions:

(1) The questions shall be asked to the best of the applicant's knowledge and belief; or

(2) The application shall include a statement that all of the answers provided are representations and are not warranties.

D. If a rider or endorsement modifies the coverage applied for, signed acceptance by the applicant is required at or before delivery of the contract.

E. A statement may not appear in the application with respect to a proxy through which one or more members of the board of directors is authorized to vote in the election of directors, or at any meeting of the board of directors.

F. If an application inquires about the applicant's participation in "hazardous activities", the application shall list the activities that are considered to be "hazardous".

G. If an application inquires about the applicant's use of "other habit-forming drugs", the application shall list the specific drugs that are considered "habit-forming".

H. If an application inquires about a symptom of an applicant, the question shall be asked about a "known symptom" of a physical condition or mental condition.

I. If an application inquires if an applicant has had any indication of a physical condition or mental condition, the question shall be asked about a "known indication" of a physical condition or mental condition.

J. Applications for Individual HMO Contracts.

(1) If an application is to be used by more than one carrier, the application shall include check-off boxes to indicate the carrier to which application is being made.

(2) Each carrier using the application shall:

(a) File the application with the Commissioner for approval; and

(b) Receive approval of use of the application from the Commissioner before using it in Maryland.

K. Applications for Group HMO Contracts.

(1) A group application may be used by more than one carrier if each carrier using the application:

(a) Files the application with the Commissioner; and

(b) Receives approval of the application from the Commissioner before using it in Maryland.

(2) If more than one carrier requests approval to use the same application with different group applicants, the application shall include check-off boxes to indicate the carrier to which application is being made.

(3) If more than one carrier requests approval to use the same application with the same group applicant, the application shall clearly identify the coverages underwritten by each carrier.

L. If an application is to be completed by more than one individual, the signature box in the application shall clearly indicate that the signature applies only to the portion of the application completed by that individual.

Md. Code Regs. 31.12.02.07

Regulation .07B amended effective May 17, 2010 (37:10 Md. R. 724)