reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-1406 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1406 - Eligibility of Individual to Enroll Under Group Plan

    (a)    A carrier may not establish rules for eligibility of an individual to enroll under a group health benefit plan based on any health status-related factor.    (b)    Subsection (a) of this section does not:        (1)    require a carrier to provide particular benefits other than those provided under the terms of the particular health benefit plan; or        (2)    prevent a carrier from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the health benefit plan.    (c)    Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.    (d)    A carrier shall allow an employee or dependent who is eligible, but not enrolled, for coverage under the terms of a group health benefit plan to enroll for coverage under the terms of the plan if:        (1)    the employee or dependent was covered under an employer-sponsored plan or group health benefit plan at the time coverage was previously offered to the employee or dependent;        (2)    the employee states in writing, at the time coverage was previously offered, that coverage under an employer-sponsored plan or group health benefit plan was the reason for declining enrollment, but only if the plan sponsor or issuer requires the statement and provides the employee with notice of the requirement;        (3)    the employee’s or dependent’s coverage described in item (1) of this subsection:            (i)    was under a COBRA continuation provision, and the coverage under that provision was exhausted; or            (ii)    was not under a COBRA continuation provision, and either the coverage was terminated as a result of loss of eligibility for the coverage, including loss of eligibility as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or employer contributions towards the coverage were terminated; and        (4)    under the terms of the plan, the employee requests enrollment not later than 30 days after:            (i)    the date of exhaustion of coverage described in item (3)(i) of this subsection; or            (ii)    termination of coverage or termination of employer contributions described in item (3)(ii) of this subsection.    (e)    A carrier shall allow an employee or dependent who is eligible, but not enrolled, for coverage under the terms of a group health benefit plan to enroll for coverage under the terms of the plan if the employee or dependent requests enrollment within 30 days after the employee or dependent is determined to be eligible for coverage under the MCHP private option plan in accordance with § 15-301.1 of the Health - General Article.
MD. Insurance Code Ann. §  15-1406.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1406.1 - Enrollment of Dependents

    (a)    In this section, “eligible employee” means:        (1)    a participant under the group health benefit plan; or        (2)    an individual who:            (i)    has met any waiting period applicable to becoming a participant under the group health benefit plan;            (ii)    is eligible to be enrolled under the plan; and            (iii)    is not a participant in the group health benefit plan because of failure to enroll during a previous enrollment period.    (b)    This section applies if a group health benefit plan makes coverage available to dependents of an eligible employee.    (c)    A group health benefit plan subject to this section shall provide a special enrollment period during which the following individuals may be enrolled under the group health benefit plan:        (1)    an individual who becomes a dependent of an eligible employee through marriage, birth, adoption, or placement for adoption;        (2)    an eligible employee who acquires a new dependent through marriage, birth, adoption, or placement for adoption; and        (3)    the spouse of an eligible employee at the birth or adoption of a child, provided the spouse is otherwise eligible for coverage.    (d)    An eligible employee may not enroll a dependent during a special enrollment period unless the eligible employee:        (1)    is enrolled under the health benefit plan; or        (2)    applies for coverage for the eligible employee during the same special enrollment period.    (e)    The special enrollment period under subsection (c) of this section shall be a period of not less than 31 days and shall begin on the later of:        (1)    the date dependent coverage is made available; or        (2)    the date of the marriage, birth, adoption, or placement for adoption, whichever is applicable.    (f)    If an eligible employee enrolls any of the individuals described in subsection (c) of this section during the first 31 days of the special enrollment period, the coverage shall become effective as follows:        (1)    in the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;        (2)    in the case of a dependent’s birth, as of the date of the dependent’s birth; and        (3)    in the case of a dependent’s adoption or placement for adoption, the date of adoption or placement for adoption, whichever occurs first.
MD. Insurance Code Ann. §  15-1407 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1407 - Premiums Based on Health Status-Related Factors

    A carrier may not require an individual member of a group to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual, based on any health status-related factor.
MD. Insurance Code Ann. §  15-1408 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1408 - Renewal of Group Health Benefit Plan

    A carrier shall renew group health benefit plans at the option of the policyholder or plan sponsor, except in any of the following cases:        (1)    for nonpayment of the required premium;        (2)    where the policyholder or plan sponsor has performed an act or practice that constitutes fraud;        (3)    where the policyholder or plan sponsor has made an intentional misrepresentation of material fact under the terms of the coverage;        (4)    where the policyholder or plan sponsor has failed to comply with a material plan provision relating to the employer contributions or group participation rules;        (5)    where the carrier elects not to renew all group health benefit plans in the State;        (6)    in the case of a health maintenance organization, where there is no longer any enrollee who lives, resides, or works in the health maintenance organization’s approved service area, provided notice of the nonrenewal is provided to each employer and to each employee covered under the health benefit plan at least 90 days before the date coverage will be terminated;        (7)    in the case of a carrier that offers coverage only through one or more bona fide associations, when the membership of an employer in the association ceases and nonrenewal under this item is applied uniformly without regard to any health status–related factor relating to any covered individual; or        (8)    the carrier makes an election under § 15–1409 of this subtitle.
MD. Insurance Code Ann. §  15-1409 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1409 - Nonrenewal of Plans

    (a)    In this section, “product” means a discrete package of health benefits that are offered using a particular product network type within a geographic service area.    (b)    A carrier that elects not to renew all of a particular product in the State shall:        (1)    provide notice of the nonrenewal at least 90 days before the date of the nonrenewal to each affected:            (i)    policyholder;            (ii)    plan sponsor;            (iii)    participant; and            (iv)    beneficiary;        (2)    offer to each affected plan sponsor the option to purchase any other health insurance coverage currently being offered by the carrier; and        (3)    act uniformly without regard to the claims experience of any affected plan sponsor, or any health status–related factor of any affected individual.    (c)    A carrier may elect not to renew all group health benefit plans in the State.    (d)    When a carrier elects not to renew all group 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; and        (3)    may not write new business for groups in the State for a 5–year period beginning on the date of notice to the Commissioner.    (e)    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.    (f)    A carrier may make a uniform modification of coverage for a product only at the time of renewal of a health benefit plan.    (g)    A carrier will not be considered to have elected not to renew all group health benefit plans in the State if the carrier complies with 45 C.F.R. § 147.106(d)(3).
MD. Insurance Code Ann. §  15-1410 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1410 - Applicability of Affordable Care Act Provisions

    (a)    In this section, “plan year” has the meaning stated in § 15–1201 of this title.    (b)    The guaranteed issuance of coverage provision in Title I, Subtitle C of the Affordable Care Act applies to each health benefit plan with a plan year that begins on or after January 1, 2014.
MD. Insurance Code Ann. §  15-1411 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms|Section 15-1411 - Disclosure of Aggregate Incurred Claims

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Aggregate incurred claims” means the total claims incurred in the experience period that the carrier uses to experience rate a large employer’s health benefit plan.        (3)    “Experience rating” means that a carrier develops the premium rates for an employer’s health benefit plan based in whole or in part on the claims experience of the group that consists of the employer’s employees or employees’ dependents.        (4)    “Large employer” means an employer that is not a small employer as defined in § 31–101 of this article.    (b)    If a carrier is experience rating a large employer’s health benefit plan, the carrier shall disclose the aggregate incurred claims of the group to the large employer within 30 days after receipt of a request from the large employer.    (c)    The aggregate incurred claims required to be disclosed under subsection (b) of this section shall be provided in a format that complies with the privacy requirements of the federal Health Insurance Portability and Accessibility Act.
MD. Insurance Code Ann. §  15-1502 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 15 - Mandated Health Insurance Services Evaluation|Section 15-1502 - Evaluation of Mandated Health Insurance Services

    (a)    (1)    The Commission shall conduct an evaluation of existing mandated health insurance services and make recommendations to the General Assembly regarding decision making criteria for reducing the number of mandates or the extent of coverage.        (2)    The evaluation shall include:            (i)    an assessment of the full cost of each existing mandated health insurance service as a percentage of the State’s average annual wage and of premiums:                1.    under a typical group and individual health benefit plan in the State;                2.    under the State employee health benefit plan; and                3.    under the Comprehensive Standard Health Benefit Plan;            (ii)    an assessment of the degree to which existing mandated health insurance services are covered in self–funded plans; and            (iii)    a comparison of mandated health insurance services provided by the State with those provided in Delaware, the District of Columbia, Pennsylvania, and Virginia.        (3)    The comparison described in paragraph (2)(iii) of this subsection shall include:            (i)    the number of mandated health insurance services;            (ii)    the type of mandated health insurance services;            (iii)    the level and extent of coverage for each mandated health insurance service; and            (iv)    the financial impact of differences in levels of coverage for each mandated health insurance service.        (4)    On or before January 1, 2004, and every 4 years thereafter, the Commission shall submit a report of its findings to the General Assembly, subject to § 2–1257 of the State Government Article.    (b)    The General Assembly may consider the information provided under subsection (a) of this section in determining:        (1)    whether to enact proposed mandated health insurance services; and        (2)    whether to repeal existing mandated health insurance services.
MD. Insurance Code Ann. §  15-1701 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 17 - Regulation of Physician Rating Systems|Section 15-1701 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Carrier” has the meaning stated in § 15–1301 of this title.    (c)    “Enrollee” means an individual entitled to health care benefits from a carrier.    (d)    “Physician rating system” means any program that:        (1)    measures, rates, or tiers the performance of physicians under contract with the carrier; and        (2)    discloses the measures, rates, or tiers to enrollees or the public.    (e)    “Ratings examiner” means an independent entity that is approved by the Maryland Health Care Commission to review physician rating systems.
MD. Insurance Code Ann. §  15-1702 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 17 - Regulation of Physician Rating Systems|Section 15-1702 - General Consideration

    (a)    A carrier may not use a physician rating system unless the physician rating system is approved by a ratings examiner.    (b)    A carrier shall contract with and pay for a ratings examiner to review any physician rating system of the carrier.    (c)    A physician rating system of a carrier is deemed to meet the requirements of this section if the physician rating system:        (1)    is approved by a ratings examiner as of January 1, 2010; and        (2)    notwithstanding any revisions to the physician rating system, maintains its approval by the ratings examiner.
MD. Insurance Code Ann. §  15-1703 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 17 - Regulation of Physician Rating Systems|Section 15-1703 - Appeals Process

    (a)    A carrier that uses a physician rating system shall:        (1)    establish an appeals process for physicians to use to contest their rating; and        (2)    at least 45 days before making available to enrollees any new or revised quality of performance or  cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide each physician included in the physician rating system with:            (i)    a notice of the proposed change;            (ii)    an explanation of the data used to assess the physician and how the physician may access the data;            (iii)    the methodology and measures used to assess the physician;            (iv)    an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and            (v)    instructions on how to file a timely appeal with the carrier.    (b)    If a physician files a timely appeal, as defined by the carrier, regarding the rating of the physician under a physician rating system, the carrier may not disclose the rating of the physician or make a change in the quality of performance or  cost–efficiency ratings of the physician until the carrier completes its investigation and renders a decision on the appeal.    (c)    A carrier shall post the following information prominently on the section of the carrier’s Web site that discloses the rating of a physician to enrollees or to the public:        (1)    where an enrollee can find the physician performance ratings of the carrier;        (2)    a disclosure that physician performance ratings are only a guide to choosing a physician because the ratings have a risk of error and should not be the sole basis for selecting a physician;        (3)    an explanation of the physician rating system, including the basis on which physician performance is measured and the basis for determining that a physician is not currently rated due to insufficient data or a pending appeal;        (4)    any limitations of the data that the carrier uses to measure physician performance;        (5)    the factors and criteria used in the carrier’s physician rating system, including quality of performance measures and cost efficiency measures; and        (6)    how a physician may appeal a physician rating.
MD. Insurance Code Ann. §  15-1704 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 17 - Regulation of Physician Rating Systems|Section 15-1704 - Notification of Results of Review; Finding of Noncompliance; Reports

    (a)    A carrier shall notify the Commissioner of the results of any final review conducted by a ratings examiner of a physician rating system of the carrier within 45 calendar days after receipt of the results by the carrier.    (b)    If the review conducted by a ratings examiner of a physician rating system of a carrier indicates that the physician rating system does not comply with the requirements of Title 19, Subtitle 1, Part V of the Health – General Article, the Commissioner may order the carrier to:        (1)    correct the deficiency; or        (2)    cease the use of the physician rating system.    (c)    A carrier using a physician rating system shall report annually to the Commissioner:        (1)    the number of appeals filed by physicians under this subtitle; and        (2)    the outcome of the appeals.
MD. Insurance Code Ann. §  15-1901 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 19 - Clinically Integrated Organizations|Section 15-1901 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Carrier” means:        (1)    an insurer;        (2)    a nonprofit health service plan; or        (3)    a health maintenance organization.    (c)    “Clinically integrated organization” means:        (1)    a joint venture between a hospital and physicians that:            (i)    has received an advisory opinion from the Federal Trade Commission or its staff; and            (ii)    has been established to:                1.    evaluate and improve the practice patterns of the health care providers; and                2.    create a high degree of cooperation, collaboration, and mutual interdependence among the health care providers who participate in the joint venture in order to promote the efficient, medically appropriate delivery of covered medical services; or        (2)    a joint venture between a hospital and physicians that:            (i)    is accountable for total spending and quality; and            (ii)    the Commissioner determines meets the criteria established by the federal Department of Health and Human Services for an accountable care organization.    (d)    “Covered medical services” means the health care services that are included as benefits under a health benefit plan issued by a carrier.    (e)    “Health benefit plan” has the meaning stated in  § 15–1301 of this title.    (f)    “Qualifying individual” means an individual covered under a health benefit plan issued by a carrier.
MD. Insurance Code Ann. §  15-1902 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 19 - Clinically Integrated Organizations|Section 15-1902 - Contract Between Carrier and a Clinically Integrated Organization

    (a)    Notwithstanding any other provision of this article or the Health – General Article, a contract between a carrier and a clinically integrated organization may include a provision to pay:        (1)    for services associated with the coordination of covered medical services to qualifying individuals; and        (2)    a bonus, fee–based incentive, bundled fees, or other incentives to promote the efficient, medically appropriate delivery of covered medical services to qualifying individuals.    (b)    The Commissioner, in consultation with the Maryland Health Care Commission, may adopt regulations specifying the types of payments and incentives permissible under this section.    (c)    (1)    A carrier shall file a copy of a contract between the carrier and a clinically integrated organization with the Commissioner.        (2)    If the contract includes a provision to pay a bonus or other incentive that does not comply with § 15–113 of this title, the Commissioner shall provide a copy of the contract to the executive director of the Maryland Health Care Commission.        (3)    Notwithstanding any other provision of law, a copy of a contract filed with the Commissioner or provided by the Commissioner to the executive director of the Maryland Health Care Commission under this subsection, is:            (i)    confidential and privileged;            (ii)    not subject to:                1.    Title 4 of the General Provisions Article;                2.    subpoena; or                3.    discovery; and            (iii)    not admissible in evidence in any private action.