Amendments to COMAR 31.11.06 for Small Group Carriers

STATE OF MARYLAND MARYLAND INSURANCE ADMINISTRATION 525 ST. PAUL PLACE, BALTIMORE, MARYLAND 21202-2272 WRITER’S DIRECT DIAL: 410-468-2205 Facsimile Number: 410-468-2204 e-mail: hmax@mdinsurance.state.md.us BULLETIN To: Small Group Carriers Re: Amendments to COMAR 31.11.06 Contract Filings Date: March 14, 2003 Bulletin: Life and Health # 03-03 The purpose of this bulletin is to notify carriers participating in the Maryland small group market of amendments to COMAR 31.11.06 Comprehensive Standard Health Benefit Plan. The proposed amendments to the regulations were published in the Maryland Register on January 24, 2003. The Maryland Health Care Commission did not receive any comments on the proposed amendments by the closing date of February 24, 2003; therefore the amended regulations are expected to be finalized as originally published, with an effective date of July 1, 2003. The amendments to these regulations will require carriers to revise their small group and selfemployed contracts that are issued or renewed on or after July 1, 2003. We recommend that the revisions to the contracts and certificates be made through an amendment rider. Please specify the form number and date of approval of the contract to which the amendment rider will be attached. To ensure approval by July 1, 2003, the filings must be received by the Maryland Insurance Administration ("Administration") by May 1, 2003. The following is a summary of the amendments to COMAR 31.11.06, which will require revisions to your contracts/certificates: ROBERT L. EHRLICH, JR. GOVERNOR MICHAEL S. STEELE LIEUTENANT GOVERNOR STEVEN B. LARSEN COMMISSIONER DONNA B. IMHOFF DEPUTY COMMISSIONER y 1, 2003, the filings must be received by the Maryland Insurance Administration ("Administration") by May 1, 2003. The following is a summary of the amendments to COMAR 31.11.06, which will require revisions to your contracts/certificates: ROBERT L. EHRLICH, JR. GOVERNOR MICHAEL S. STEELE LIEUTENANT GOVERNOR STEVEN B. LARSEN COMMISSIONER DONNA B. IMHOFF DEPUTY COMMISSIONER 1. New Required Definitions a. Congenital or Genetic Birth Defect Definition--See COMAR 31.11.06.02B(5) b. Residential Crisis Services Definition--See COMAR 31.11.06.02B(54) 2. New Residential Crisis Services Benefit--See COMAR 31.11.06.03A(4). The inpatient benefit for mental health and substance abuse services was revised to include residential crisis services. 3. Revised Exclusion for Dental Services--See COMAR 31.11.06.06B(28). The words "the accident occurs while the patient is insured and" were deleted from this exclusion. The federal Department of Labor brought this exclusion to the Administration's attention as a violation of the Health Insurance and Portability Act of 1996 (HIPAA). Treatment of teeth due to an accident is required to be covered if the treatment is received within 6 months of the accident. Please note that although the regulations are being amended as of July 1, 2003, the requirements of HIPAA would prohibit the application of this portion of the exclusion since the effective date of HIPAA. Attached to this bulletin is a copy of the amended regulations, as published January 24, 2003 in the Maryland Register. Any questions about this bulletin should be directed to the Life/Health Section of the Maryland Insurance Administration at 410-468-2170. _________________________ Howard Max Acting Associate Commissioner Life and Health Enclosure