Md. Code Regs. 31.10.05.06

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

Section 31.10.05.06 - Prohibited Policy Provisions

A. Waivers may not be included in or attached to a Medicare supplement policy if the effect of the waivers is to exclude, limit, or reduce coverage or benefits for specifically named or described diseases or physical conditions.

B. A Medicare supplement policy or subscriber contract may not be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy or subscriber contract if the policy or contract limits or excludes coverage by type of illness, accident, treatment, or medical condition, except for the following, provided however, that if any of the following limitations or exclusions are contained in a Medicare supplement policy, the limitation or exclusion may not be more restrictive than that applicable to the Medicare program:

(1) Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or symptomatic complaints of the feet;

(2) Mental or emotional disorders, alcoholism, and drug addiction;

(3) Illness, treatment, or medical condition arising out of:

(a) War or act of war (whether declared or undeclared), participation in a felony, riot or insurrection, service in the armed forces or auxiliary units,

(b) Suicide while sane or insane, attempted suicide, or intentionally self-inflicted injury, or

(c) Aviation or air travel other than as a fare-paying passenger on a regularly scheduled airline or on a group-chartered plane;

(4) Cosmetic surgery, but this exclusion may not apply to reconstructive surgery when the surgery is incidental to or follows surgery resulting from trauma, infection, or diseases of the involved part;

(5) Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference and their effects, if the interference is the result of or related to distortion, misalignment or subluxation of, or in, the vertebral column;

(6) Treatment provided in a federal government hospital, benefits provided under Medicare or other governmental program (except Medicaid), any workers' compensation, employer's liability or occupational disease or similar law, or any motor vehicle no-fault or similar law;

(7) Services rendered by, and separately billed by, the employees of hospitals, laboratories, or other institutions;

(8) Services performed by a member of the covered person's immediate family, and services for which no charge is normally made in the absence of insurance;

(9) Dental care or treatment;

(10) Eyeglasses, hearing aids, and examination for their prescription or fitting;

(11) Rest cures, custodial care, transportation, and routine physical examinations;

(12) Territorial limitations outside the United States; and

(13) Coverage of any expense to the extent of any benefit available to the insured under Medicare.

C. The terms "Medicare supplement", "Medigap", and words of similar import may not be used in connection with the advertisement, solicitation, or policy description or title unless the policy is issued in compliance with these regulations.

D. A Medicare supplement policy, contract, or certificate in force in this State may not include benefits which duplicate benefits provided by Medicare.

E. An insurer may not deny, reduce, or condition coverage or apply an increased premium rating to an applicant for a Medicare supplement policy by reason of the applicant's health status, claims experience, medical condition, or use of medical care if the applicant applies for the Medicare supplement policy within the first 6 months after becoming eligible for Medicare by reason of age. However, the insurer may include a provision with regard to preexisting conditions which complies with Regulation .07B(1) of this chapter.

Md. Code Regs. 31.10.05.06

Regulations .06, Appendixes A_C adopted as an emergency provision effective July 1, 1982 (9:13 Md. R. 1340); adopted permanently effective October 1, 1982 (9:17 Md. R. 1707)
Regulations .06 and Appendices A_C repealed, and new Regulations .06 and Appendices A_C adopted as an emergency provision effective July 25, 1989 (16:16 Md. R. 1738); emergency status extended at 16:26 Md. R. 2782 and 17:5 Md. R. 633; emergency status expired July 20, 1990
Regulations .06 and Appendices A_C repealed, and new Regulations .06 adopted effective July 23, 1990 (17:14 Md. R. 1757)
Regulation .06E adopted effective November 11, 1991 (18:22 Md. R. 2396)