reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-1218 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1218 - Reinsurance

    (a)    A reinsuring carrier may reinsure with the Pool as provided in this section.    (b)    At a minimum, the Pool shall reinsure up to the level of coverage specified under the Standard Plan.    (c)    A reinsuring carrier may reinsure an entire employer group within 60 days after commencement of the group’s coverage under a health benefit plan.    (d)    (1)    A reinsuring carrier may reinsure an eligible employee or dependent within 60 days after commencement of coverage with the small employer.        (2)    A reinsuring carrier may reinsure a newly eligible employee or dependent within 60 days after commencement of coverage of the eligible employee or dependent.    (e)    (1)    The Pool may not reimburse a reinsuring carrier with respect to the claims of an individual until the reinsuring carrier has incurred claims for the individual of $5,000 in a calendar year for benefits covered by the Pool.        (2)    After the initial $5,000 of incurred claims, the reinsuring carrier is responsible for 10% of the next $50,000 of incurred claims during the calendar year, and the Pool shall reinsure the remainder.        (3)    The liability of a reinsuring carrier under this subsection may not exceed $10,000 in any 1 calendar year with respect to any individual.    (f)    (1)    The Board annually shall adjust the initial level of claims and the maximum limit to be retained by the reinsuring carrier to reflect increases in costs and utilization within the standard market for health benefit plans in the State.        (2)    Unless the Board proposes and the Commissioner approves a lower adjustment factor, the adjustment in paragraph (1) of this subsection may not be less than the annual change in the medical component of the “Consumer Price Index for all Urban Consumers” of the Department of Labor, Bureau of Labor Statistics.    (g)    A reinsuring carrier may terminate reinsurance on a plan anniversary for one or more of the individuals in a small employer group.
MD. Insurance Code Ann. §  15-1219 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1219 - Premiums for Reinsurance

    (a)    (1)    (i)    As part of the plan of operation, the Board shall establish a methodology to determine premium rates to be charged by the Pool to reinsure small employers and individuals under this section and § 15-1218 of this subtitle.            (ii)    The methodology shall provide for the development of base reinsurance premium rates that shall be multiplied by the factors set forth in paragraph (2) of this subsection to determine the premium rates for the Pool.            (iii)    The Board shall establish the base reinsurance premium rates at levels that reasonably approximate gross premiums charged to small employers by carriers for health benefit plans up to the level of coverage that the Board determines.        (2)    Premiums for the Pool shall be as follows:            (i)    an entire group may be reinsured for a rate that is 1.5 times the base reinsurance premium rate for the group established under this subsection; and            (ii)    an individual may be reinsured for a rate that is 5 times the base reinsurance premium rate for the individual established under this subsection.        (3)    (i)    The Board periodically shall review the methodology established under paragraph (1) of this subsection, including the system of classification and any rating factors, to ensure that it reasonably reflects the claims experience of the Pool.            (ii)    The Board may propose changes to the methodology, subject to the approval of the Commissioner.    (b)    If a health benefit plan for a small employer is entirely or partially reinsured with the Pool, the premium charged to the small employer for any rating period for the coverage issued shall meet the requirements that relate to premium rates set forth in § 15-1205 of this subtitle.
MD. Insurance Code Ann. §  15-1220 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1220 - Management of Pool Money

    (a)    The Pool shall manage and invest all money collected by or on behalf of the Pool through premium charges, assessments, earnings from investments, or otherwise, through a financial management committee composed of the Executive Director and two members of the Board.    (b)    All operating expenses of the Pool shall be paid from funds collected by or on behalf of the Pool.    (c)    The account of the Pool is a special fund account and the money in the account is not part of the General Fund of the State.    (d)    The State may not provide General Fund appropriations to the Pool and the obligations of the Pool are not a debt of the State or a pledge of the credit of the State.    (e)    All debts, claims, obligations, and liabilities of the Pool, whenever incurred, shall be the debts, claims, obligations, and liabilities of the Pool only and not of the State or the State’s agencies, instrumentalities, officers, or employees.    (f)    The Pool is exempt from:        (1)    taxation by the State and local government;        (2)    the general procurement law provisions of Division II of the State Finance and Procurement Article; and        (3)    Division I of the State Personnel and Pensions Article.
MD. Insurance Code Ann. §  15-1222 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1222 - Reports; Audits

    (a)    (1)    The Board shall report to the Commissioner on or before June 1 of each year.        (2)    At a minimum, the report shall include:            (i)    a description of the operations of the Pool for the preceding calendar year;            (ii)    an audited statement of the financial condition of the Pool as of the preceding December 31; and            (iii)    an audited detailed statement of the revenues received and expenditures of the Pool made during the preceding calendar year.    (b)    The operations of the Board are subject to an annual audit by an independent auditor, and the audit report and working papers are subject to review by the Legislative Auditor.
MD. Insurance Code Ann. §  15-1223 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1223 - Immunity of Pool and Reinsuring Carriers

    Participation in the Pool as reinsuring carriers, establishment of rates, forms, or procedures, or any other joint or collective action required by §§ 15-1218, 15-1219, and 15-1221 of this subtitle may not be the basis of any legal action, criminal or civil liability, or penalty against the Pool or any of its reinsuring carriers either jointly or separately.
MD. Insurance Code Ann. §  15-1224 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1224 - Dissolution of Pool

    The Commissioner may order the dissolution of the Pool if the Commissioner determines that the Pool is not financially viable, and provision is made to ensure the protection of those insured by the members of the Pool.
MD. Insurance Code Ann. §  15-1225 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1225 - Short Title

    This subtitle is the Maryland Health Insurance Reform Act.
MD. Insurance Code Ann. §  15-1302 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1302 - Scope of Subtitle

    (a)    This subtitle applies to all carriers that offer health benefit plans to individuals in the State.    (b)    This subtitle does not apply to a carrier that offers only conversion policies as required by law.    (c)    This subtitle does not apply to a carrier that offers health insurance coverage only in connection with group health plans.
MD. Insurance Code Ann. §  15-1303 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1303 - Requirements for Carriers

    (a)    In addition to any other requirements under this article, a carrier that offers individual health benefit plans in the State shall:        (1)    have demonstrated the capacity to administer the individual health benefit plans, including adequate numbers and types of administrative staff;        (2)    have a satisfactory grievance procedure and ability to respond to calls, questions, and complaints from enrollees or insureds; and        (3)    design policies to help ensure that enrollees or insureds have adequate access to providers of health care.    (b)    (1)    Except as provided in this subsection and § 31–110(f) of this article, a carrier may not offer individual health benefit plans in the State unless the carrier also offers qualified health plans, as defined in § 31–101 of this article, in the Individual Exchange of the Maryland Health Benefit Exchange in compliance with the requirements of Title 31 of this article.        (2)    A carrier is exempt from the requirement in paragraph (1) of this subsection if:            (i)    1.    the reported total aggregate annual earned premium from all individual health benefit plans in the State for the carrier and any other carriers in the same insurance holding company system, as defined in § 7–101 of this article, is less than $10,000,000; or                2.    the only individual health benefit plans that the carrier offers in the State are student health plans as defined in 45 C.F.R. § 147.145;            (ii)    the Commissioner determines that the carrier complies with the procedures established under paragraph (3) of this subsection; and            (iii)    when the carrier ceases to meet the requirements for the exemption, the carrier provides to the Commissioner immediate notice and its plan for complying with the requirement in paragraph (1) of this subsection.        (3)    The Commissioner shall establish procedures for a carrier to submit evidence each year that the carrier meets the requirements necessary to qualify for an exemption under paragraph (2) of this subsection.        (4)    Notwithstanding the exemption provided in paragraph (2) of this subsection, any carrier that offers a catastrophic plan, as defined by the Affordable Care Act, in the State also must offer at least one catastrophic plan in the Maryland Health Benefit Exchange.        (5)    Notwithstanding the exemption provided in paragraph (2) of this subsection, the Commissioner, in consultation with the Maryland Health Benefit Exchange:            (i)    may assess the impact of the exemption provided in paragraph (2) of this subsection and, based on that assessment, alter the limit on the amount of annual premiums that may not be exceeded to qualify for the exemption; and            (ii)    shall make any change in the exemption requirement by regulation.
MD. Insurance Code Ann. §  15-1307 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1307 - Actuarial Value of Benefits

    (a)    The actuarial value of benefits provided under individual health insurance coverage shall be calculated based on a standardized population and a set of standardized utilization and cost factors.    (b)    A carrier shall submit any information the Commissioner may require to support and justify the carrier’s calculations of actuarial values.
MD. Insurance Code Ann. §  15-1308 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1308 - Individual Health Benefit Plans

    (a)    In this section, “affiliate” means a person that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another person.    (b)    A carrier may elect not to renew all individual health benefit plans in the State.    (c)    When a carrier elects not to renew all individual health benefit plans in the State, the carrier:        (1)    shall give notice of its decision to the affected individuals at least 180 days before the effective date of nonrenewal;        (2)    at least 30 working days before that notice, shall give notice to the Commissioner;        (3)    if the carrier has an affiliate in the individual market, shall give notice to each affected individual at least 180 days before the effective date of nonrenewal of the individual’s option to purchase all other individual health benefit plans currently offered by the affiliate of the carrier; and        (4)    may not write new business for individuals in the State for a 5-year period beginning on the date of notice to the Commissioner.    (d)    A carrier that offers an individual health benefit plan shall offer an individual health benefit plan to an individual who is nonrenewed by an affiliate of the carrier under subsection (c) of this section on a guarantee issue basis, if the individual applies for coverage no later than 63 days after the effective date of nonrenewal.    (e)    A carrier that issues coverage under subsection (d) of this section may not rate the coverage on a substandard basis unless the individual was rated on a substandard basis under the prior coverage provided to the individual by the affiliate of the carrier.    (f)    (1)    Subject to paragraph (2) of this subsection, a carrier that issues coverage under subsection (d) of this section shall waive the waiting period for coverage of a preexisting condition to the extent that the individual has satisfied a waiting period under the individual’s prior contract or policy.        (2)    The carrier that issues coverage under subsection (d) of this section may require the individual to satisfy the remaining part of the waiting period if any part of the waiting period under the individual’s prior contract or policy has not been satisfied, unless the coverage issued under subsection (d) of this section has a shorter waiting period.    (g)    A health maintenance organization need not offer coverage to an individual who does not live, reside, or work within the health maintenance organization’s approved service areas.    (h)    A carrier will not be considered to have elected not to renew all individual health benefit plans in the State if the carrier complies with 45 C.F.R. § 147.106(d)(3).
MD. Insurance Code Ann. §  15-1313 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1313 - List of Carriers That Provide Individual Health Benefit Plans

    The Administration shall provide on its Web site and in printed form on request a list of carriers, including contact information for each carrier, that offer individual health benefit plans in the State.
MD. Insurance Code Ann. §  15-1314 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1314 - Increasing Individual Premiums on Health Benefit Plans

    (a)    Except as provided in subsection (c) of this section, a carrier may not increase an individual’s premium on an individual health benefit plan more frequently than once every 12 months.    (b)    An increase in an individual’s premium described in subsection (a) of this section includes an increase due to the individual moving into a higher age band.    (c)    A carrier may increase an individual’s premium on an individual health benefit plan more frequently than once every 12 months if the premium increase is due solely to the enrollment of a new family member to the individual health benefit plan of the individual.
MD. Insurance Code Ann. §  15-1315 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1315 - Plans Issued Through Individual Exchange

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Individual Exchange” has the meaning stated in § 31–101 of this article.        (3)    “Qualified health plan” has the meaning stated in § 31–101 of this article.        (4)    “Qualified individual” has the meaning stated in § 31–101 of this article.    (b)    This section applies to a qualified health plan that is issued on or after January 1, 2014, by a carrier through the Individual Exchange.    (c)    A qualified health plan subject to this section shall include a grace period provision applicable to a qualified individual who:        (1)    is receiving advance payments of federal premium tax credits; and        (2)    fails to pay premiums timely.    (d)    The grace period provision shall:        (1)    provide a grace period of 3 consecutive months after the initial premium payment to begin coverage has been paid;        (2)    apply to qualified health plans renewed in accordance with § 15–1309 of this subtitle without the qualified individual having to pay the first month’s premium following renewal; and        (3)    be in addition to any other grace period provision required by any other applicable State law.    (e)    During the grace period, a carrier that issues a qualified health plan subject to this section:        (1)    shall pay all appropriate claims for services rendered to the qualified individual during the first month of the grace period;        (2)    may pend claims for services rendered to the qualified individual in the second and third months of the grace period;        (3)    shall notify the federal Department of Health and Human Services that the qualified individual is in the grace period; and        (4)    shall notify providers of the possibility that claims may be denied when a qualified individual is in the second and third months of the grace period.
MD. Insurance Code Ann. §  15-1317 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1317 - Initial Open Enrollment Period

    (a)    A carrier that sells health benefit plans to individuals in the State shall establish an initial open enrollment period that begins October 1, 2013, and extends through March 31, 2014.    (b)    A carrier shall accept all applicants who apply for coverage during the initial open enrollment period.    (c)    If an application is received by a carrier during the initial open enrollment period, coverage for the applicant shall begin no later than:        (1)    January 1, 2014, if the application is received on or before December 15, 2013;        (2)    the first day of the following month, if the application is received between the first and fifteenth day, inclusive, of January, February, or March; and        (3)    the first day of the second following month, if the application is received between the sixteenth day and the last day, inclusive, of December, January, February, or March.
MD. Insurance Code Ann. §  15-1318 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms|Section 15-1318 - Student Health Plans

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Institution of higher education” has the meaning stated in the federal Higher Education Act of 1965.        (3)    “Student administrative health fee” means a fee charged by an institution of higher education on a periodic basis to students of the institution of higher education to offset the cost of providing health care through health clinics regardless of whether the students utilize the health clinics or enroll in student health plan coverage.        (4)    “Student health plan” means an individual health benefit plan that is provided to students enrolled in an institution of higher education and their dependents under a written agreement that:            (i)    is between the institution of higher education and a carrier;            (ii)    does not make coverage under the health benefit plan available other than in connection with enrollment as a student or as a dependent of a student in the institution of higher education; and            (iii)    does not condition eligibility for the health benefit plan on any health status–related factor relating to a student or a dependent of a student.    (b)    A carrier that offers student health plans is not required to:        (1)    accept individuals who are not:            (i)    students; or            (ii)    dependents of students covered under the student health plan;        (2)    establish open enrollment periods;        (3)    establish effective dates that are based on a calendar year;        (4)    offer health benefit plan contracts that are on a calendar year basis; or        (5)    renew, or continue in force, coverage for individuals who are no longer students or dependents of students.    (c)    A student health plan is not subject to the requirement of a single risk pool under § 1312(c) of the Affordable Care Act.    (d)    A student health plan shall comply with the requirements of 45 C.F.R. § 147.145, as interpreted and implemented by the federal Centers for Medicare and Medicaid Services.    (e)    A student administrative health fee is not considered a cost–sharing requirement with respect to specified recommended preventive services.
MD. Insurance Code Ann. §  15-1402 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1402 - Scope of Subtitle

    (a)    Subject to subsection (b) of this section, this subtitle applies to all carriers in connection with group health benefit plans.    (b)    This subtitle does not apply to policies issued under Subtitle 12 of this title.