Producer Enrollment Forms

STATE OF MARYLAND MARYLAND INSURANCE ADMINISTRATION 525 ST. PAUL PLACE, BALTIMORE, MARYLAND 21202-2272 WRITER’S DIRECT DIAL: 410-468-2201 Facsimile Number: 410-468-2204 e-mail : wtaparanskas@mdinsurance.state.md.us BULLETIN To: Compliance Officer Life Insurers Health Insurers Health Maintenance Organizations Nonprofit Health Service Plans Fraternal Benefit Societies Dental Plan Organizations Third Party Administrators Re: Producer Enrollment Forms Date: November 14, 2001 Bulletin No: Life and Health 01-15 The purpose of this bulletin is to provide information in response to questions concerning the use of a Producer Enrollment Form and whether the form requires approval before use in the State. A Producer Enrollment Form is a form developed by a producer or third party administrator for an employer sponsored benefit package and used in the group life/health market to enroll employees in insurance or HMO coverage. All life, health and HMO application forms used in Maryland are required to be approved by this Administration prior to use. However, a Producer Enrollment Form is not an application form if all the following are satisfied: 1. The form is not part of the group contract; 2. The coverage in which the employee enrolls is guaranteed issue only; 3. The form is not used for medical underwriting purposes; and PARRIS N. GLENDENING GOVERNOR KATHLEEN KENNEDY TOWNSEND LIEUTENANT GOVERNOR STEVEN B. LARSEN COMMISSIONER DONNA B. IMHOFF DEPUTY COMMISSIONER WENDY TAPARANSKAS ASSOCIATE COMMISSIONER LIFE & HEALTH 4. The following statement is clearly visible on the form: "THIS IS NOT AN APPLICATION FOR INSURANCE" If all four criteria are satisfied, a producer enrollment form need not be filed and is not required to be approved before use in Maryland. If the Producer Enrollment Form is used to enroll employees in HMO coverage, the form is subject to Health-General Article, §19-705.1(d)(4)(ii), Annotated Code of Maryland, which requires the following statement to appear in bold type on every enrollment card: "If you have any questions concerning the benefits and services that are provided by or excluded under this agreement, please contact a membership services representative before signing this enrollment card." If you have any questions on this matter, please call (410) 468-2170 and mention this bulletin by bulletin number. _________________________ Wendy J. Taparanskas, Ph.D. Associate Commissioner Life and Health word/data/bltns-ml/2001/Bulletin 01-15.doc (BW)lrl