§ 15-508.1. Exclusionary provisions [Subject to amendment effective January 1, 2014; amended version follows this section]

   (a) Definitions. --

   (1) In this section the following words have the meanings indicated.

   (2) "Carrier" means an insurer or a nonprofit health service plan.

   (3) "Creditable coverage" has the meaning stated in § 15-1301 of this title.

   (4) "Exclusionary rider" means an endorsement to an individual health benefit plan that excludes benefits for one or more named conditions that are discovered by a carrier during the underwriting process.

   (5) "Health benefit plan" has the meaning stated in § 15-1301 of this title.

   (6) "Individual health benefit plan" means a health benefit plan issued by a carrier that insures:

      (i) only one individual; or

      (ii) one individual and one or more family members of the individual.

(b) Exclusionary rider. -- A carrier may not attach an exclusionary rider to an individual health benefit plan unless the carrier obtains the prior written consent of the policyholder.

(c) Preexisting condition exclusion or limitation. -- Except as provided in subsection (d) of this section, a carrier may impose a preexisting condition exclusion or limitation on an individual for a condition that was not discovered during the underwriting process for an individual health benefit plan only if the exclusion or limitation:

   (1) relates to a condition of the individual, regardless of its cause, for which medical advice, diagnosis, care, or treatment was recommended or received within the 12-month period immediately preceding the effective date of the individual's coverage;

   (2) extends for a period of not more than 12 months after the effective date of the individual's coverage; and

   (3) is reduced by the aggregate of any applicable periods of creditable coverage.

(d) Preexisting condition exclusion or limitation -- Exception. --

   (1) Subject to paragraph (2) of this subsection, a carrier may not impose a preexisting condition exclusion or limitation on an individual who, as of the last day of the 30-day period beginning with the date of the individual's birth, is covered under any creditable coverage.

   (2) The limitation on the imposition of a preexisting condition exclusion or limitation under paragraph (1) of this subsection does not apply after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.

HISTORY: 2009, chs. 509, 653.