1. A. Before entering into a policy or contract of medical stop-loss insurance with a small employer, a carrier shall provide the small employer a completed medical stop-loss insurance disclosure form.
2. B. When determining whether an employer satisfies the definition of a small employer, the carrier shall base the determination on the definition that applies on the proposed effective date of the medical stop-loss insurance policy or contract.
3. C. The medical stop-loss insurance disclosure form shall be printed in at least 12-point type.

4. D. The portion of the medical stop-loss insurance disclosure form that requires a listing of any limitations in the medical stop-loss insurance policy or contract is required to include any:

   1. (1) Dollar limitations in the medical stop-loss insurance policy or contract, such as annual limitations;
   2. (2) Day or visit limits on the services covered under the medical stop-loss insurance policy or contract;

   3. (3) Limitations or exclusions that apply to benefits covered under the medical stop-loss insurance policy or contract, such as:

      1. (a) Pre-existing condition exclusions;
      2. (b) Exclusions or limitations for particular services, such as an exclusion or limitation for prescription drugs or mental health services;
      3. (c) Exclusions or limitations for particular medical conditions, such as AIDS;
      4. (d) Limitations or exclusions for non-medically necessary services; and
      5. (e) Limitations or exclusions for experimental or investigational services; and
   4. (4) Different attachment points for any particular service, such as organ transplants.

Authority: Insurance Article, §§2-109(a)(1) and 15-129(f)(3), Annotated Code of Maryland

Effective date:

Regulations .01—.04 adopted effective January 1, 2016 (42:23 Md. R. 1436)