reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-1204 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1204 - Requirements and Limitations for Carriers

    (a)    This section applies to a carrier with respect to any health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act.    (b)    In addition to any other requirement under this article, a carrier shall:        (1)    have demonstrated the capacity to administer the health benefit plan, including adequate numbers and types of administrative personnel;        (2)    have a satisfactory grievance procedure and ability to respond to enrollees’ calls, questions, and complaints;        (3)    provide, in the case of individuals covered under more than one health benefit plan, for coordination of coverage under all of those health benefit plans in an equitable manner; and        (4)    design policies to help ensure adequate access to providers of health care.    (c)    A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.    (d)    A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.    (e)    A carrier may offer benefits in addition to those in the Standard Plan if:        (1)    the additional benefits:            (i)    are offered and priced separately from benefits specified in accordance with § 15–1207 of this subtitle; and            (ii)    do not have the effect of duplicating any of those benefits; and        (2)    the carrier:            (i)    clearly distinguishes the Standard Plan from other offerings of the carrier;            (ii)    indicates the Standard Plan is the only plan required by State law; and            (iii)    specifies that all enhancements to the Standard Plan are not required by State law.    (f)    Notwithstanding subsection (c) of this section, a health maintenance organization may provide a point of service delivery system as an additional benefit through another carrier regardless of whether the other carrier also offers the Standard Plan.    (g)    A carrier may offer coverage for dental care and services as an additional benefit.    (h)    (1)    In this subsection, “prominent carrier” means a carrier that insures at least 10% of the total lives insured in the small group market.        (2)    (i)    A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.            (ii)    A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.        (3)    A carrier may not condition the sale of a wellness benefit to a small employer on participation of the eligible employees of the small employer in wellness programs or activities.
MD. Insurance Code Ann. §  15-1204.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1204.1 - Carrier Required to Offer Qualified Health Plans in Small Business Health Options Program in Compliance With Title 31 Along With Other Health Benefit Plans to Small Employers

    (a)    This section applies to a carrier with respect to any health benefit plan that:        (1)    is not a grandfathered health plan, as defined in § 1251 of the Affordable Care Act; and        (2)    is issued, delivered, or renewed in the State on or after January 1, 2014.    (b)    (1)    Except as provided in this subsection and § 31–110(f) of this article, a carrier may not offer health benefit plans to small employers in the State unless the carrier also offers qualified health plans, as defined in § 31–101 of this article, in the Small Business Health Options Program 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)    the reported total aggregate annual earned premium from all health benefit plans offered to small employers 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 $20,000,000;            (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, 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. §  15-1207 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1207 - Comprehensive Standard Health Benefit Plan and Modified Plans

    (a)    In accordance with Title 19, Subtitle 1 of the Health – General Article, the Commission shall adopt regulations that specify:        (1)    the Comprehensive Standard Health Benefit Plan to apply under this subtitle; and        (2)    the requirements for a wellness benefit offered by a carrier to apply under this subtitle.    (b)    (1)    Subject to paragraph (2) of this subsection, the Commission shall exclude or limit benefits or adjust cost–sharing arrangements in the Standard Plan if the average rate for the Standard Plan exceeds 10% of the average annual wage in the State.        (2)    The Commission annually shall determine the average rate for the Standard Plan by using the average rate submitted by each carrier that offers the Standard Plan.    (c)    In establishing benefits, the Commission shall judge preventive services, medical treatments, procedures, and related health services based on:        (1)    their effectiveness in improving the health status of individuals;        (2)    their impact on maintaining and improving health and on reducing the unnecessary consumption of health care services; and        (3)    their impact on the affordability of health care coverage.    (d)    The Commission may exclude:        (1)    a health care service, benefit, coverage, or reimbursement for covered health care services that is required under this article or the Health – General Article to be provided or offered in a health benefit plan that is issued or delivered in the State by a carrier; or        (2)    reimbursement required by statute, by a health benefit plan for a service when that service is performed by a health care provider who is licensed under the Health Occupations Article and whose scope of practice includes that service.    (e)    The Commission shall include mental health and substance abuse benefits required under § 15–802 of this title and § 19–703.1 of the Health – General Article for employers that meet the large employer definition under § 15–802 of this title and § 19–703.1 of the Health – General Article.    (f)    The Commission shall specify the deductibles and cost–sharing associated with the benefits in the Standard Plan.    (g)    In establishing cost–sharing as part of the Standard Plan, the Commission shall:        (1)    include cost–sharing and other incentives to help prevent consumers from seeking unnecessary services;        (2)    balance the effect of cost–sharing in reducing premiums and in affecting utilization of appropriate services; and        (3)    limit the total cost–sharing that may be incurred by an individual in a year.    (h)    Beginning January 1, 2014, this section applies only to grandfathered health plans as defined in § 1251 of the Affordable Care Act.
MD. Insurance Code Ann. §  15-1208 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1208 - Applicability of 15-508

    The provisions of § 15–508 of this title apply to a policy or certificate issued to a small employer.
MD. Insurance Code Ann. §  15-1209 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1209 - Issuance of Health Benefit Plans

    (a)    This section does not apply to any insurance enumerated in § 15–1201(i)(3)(i) through (xiii) of this subtitle.    (b)    A carrier shall issue its health benefit plans to each small employer that meets the requirements of this section.    (c)    (1)    Nothing in this subsection requires a small employer to contribute to the premium payments for coverage of a dependent of an eligible employee.        (2)    To be covered under a health benefit plan offered by a carrier, a small employer shall:            (i)    elect to be covered;            (ii)    agree to pay the premiums;            (iii)    agree to offer coverage to any dependent of an eligible employee when coverage is sought by the eligible employee, in accordance with provisions governing late enrollees and any other provisions of this subtitle that apply to coverage;            (iv)    agree to collect payments for premiums through payroll deductions for coverage of eligible employees and dependents and transmit those payments to the carrier or the SHOP Exchange, as applicable; and            (v)    satisfy other reasonable provisions of the health benefit plan as approved by the Commissioner.    (d)    (1)    In determining whether a small employer satisfies the requirements of this section, a carrier shall apply its requirements uniformly among all small employers with the same number of eligible employees who apply for or receive coverage from the carrier, including a requirement that a minimum percentage of eligible employees of the small employer participate in the health benefit plan.        (2)    A carrier may vary application of minimum participation of eligible employees only by the size of the group of the small employer.    (e)    A carrier may not require a small employer to contribute to payment of premiums for a health benefit plan.
MD. Insurance Code Ann. §  15-1210 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1210 - Offering of Coverage by Carriers

    (a)    A carrier that offers coverage to a small employer shall:        (1)    offer coverage to all of its eligible employees and all of their eligible dependents; and        (2)    at the election of the small employer, offer coverage to all of its part–time employees who have a normal workweek of at least 17 1/2 but less than 30 hours per week.    (b)    (1)    A health maintenance organization need not offer coverage:            (i)    to a small employer that is outside of the health maintenance organization’s approved service areas;            (ii)    to an eligible employee who resides outside of the health maintenance organization’s approved service areas; or            (iii)    within an area where the health maintenance organization reasonably anticipates, and demonstrates to the satisfaction of the Commissioner, that it will not have the capacity in its network of providers to deliver service adequately because of obligations to existing group contract holders and enrollees.        (2)    A health maintenance organization that does not offer coverage under paragraph (1)(iii) of this subsection may not offer coverage in the applicable area to any employer groups until the later of:            (i)    180 days after a refusal to do so; or            (ii)    the date on which the health maintenance organization notifies the Commissioner that it has regained capacity to deliver services to small employer groups in that area.    (c)    A carrier may not be required to offer coverage under §§ 15–1209 and 15–1213 of this subtitle for as long as the Commissioner finds that the coverage would place the carrier in a financially impaired condition.
MD. Insurance Code Ann. §  15-1211 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1211 - Approval of Proposed Health Benefit Plans

    (a)    To sell health benefit plans to small employers in the State, a carrier shall file its proposed health benefit plans with the Commissioner on or before the date designated by the Commissioner.    (b)    Unless the Commissioner previously has disapproved a health benefit plan, it is deemed approved 60 days after filing with the Commissioner.
MD. Insurance Code Ann. §  15-1213 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1213 - Benefits Additional to Standard Plan

    (a)    This section does not apply to any insurance enumerated in § 15–1201(i)(3)(i) through (xiii) of this subtitle.    (b)    Each benefit offered in addition to the Standard Plan that increases access to care choices or lowers the cost–sharing arrangement in the Standard Plan is subject to all of the provisions of this subtitle applicable to the Standard Plan, including:        (1)    guaranteed issuance;        (2)    guaranteed renewal; and        (3)    adjusted community rating.    (c)    (1)    Each benefit offered in addition to the Standard Plan that increases the type of services available or the frequency of services is not subject to guaranteed issuance but is subject to all other provisions of this subtitle applicable to the Standard Plan, including:            (i)    guaranteed renewal; and            (ii)    adjusted community rating.        (2)    For each additional benefit offered under this subsection, a carrier shall accept or reject the application of the entire group.        (3)    The Commissioner may prohibit a carrier from offering an additional benefit under this subsection if the Commissioner finds that the additional benefit will be sold in conjunction with the Standard Plan in a manner designed to promote risk selection or underwriting practices otherwise prohibited by this subtitle.    (d)    (1)    A benefit offered in addition to the Standard Plan to lower the cost–sharing arrangement in the Standard Plan in accordance with § 15–301.1 of the Health – General Article is subject to:            (i)    guaranteed issuance;            (ii)    guaranteed renewal; and            (iii)    adjusted community rating.        (2)    A carrier that offers a benefit under this subsection shall be required to guarantee issuance and guarantee renewal of the additional benefit only to employers who are participating in the MCHP private option plan established under § 15–301.1 of the Health – General Article.    (e)    Beginning January 1, 2014, this section applies only to grandfathered health plans as defined in § 1251 of the Affordable Care Act.
MD. Insurance Code Ann. §  15-1214 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1214 - Reimbursement of Hospitals

    Notwithstanding any other provision of this subtitle, health benefit plans shall reimburse hospitals in accordance with rates approved by the State Health Services Cost Review Commission.
MD. Insurance Code Ann. §  15-1215 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1215 - Election to Become Risk-Assuming Carrier or Reinsuring Carrier

    (a)    (1)    Each carrier shall elect to become either a risk-assuming carrier or reinsuring carrier.        (2)    The notification of election to become a risk-assuming carrier shall include an appropriate opinion by an independent qualified actuary that the risk-assuming carrier is able to assume and manage the risk of enrolling groups under this subtitle without the protection of the Pool.    (b)    (1)    The initial election under this section is binding for 3 years.        (2)    After the initial 3 years, and every 5 years thereafter, each carrier shall again elect to be either a risk-assuming or reinsuring carrier.        (3)    Each subsequent election is binding for 5 years.        (4)    The Commissioner may allow a new carrier to make an election under conditions established by the Commissioner.    (c)    (1)    The Commissioner may allow a carrier to change its election at any time for good cause shown.        (2)    In determining whether to approve an application by a carrier to change its election, the Commissioner shall consider:            (i)    the applicant’s financial condition and the financial condition of any parent or guaranteeing corporation;            (ii)    the applicant’s history of assuming and managing risk;            (iii)    the applicant’s commitment to market fairly to all small employers in the State or in the applicant’s service area;            (iv)    the applicant’s ability to assume and manage the risk of enrolling groups under this subtitle without the protection of the Pool; and            (v)    the effect of approval of the application on the financial viability of the Pool.        (3)    While the Commissioner is considering an application under this subsection, the carrier may request a hearing as provided under Title 11, Subtitle 5 of this article.
MD. Insurance Code Ann. §  15-1216 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1216 - Small Employer Health Reinsurance Pool

    (a)    The Commissioner shall establish the Maryland Small Employer Health Reinsurance Pool.    (b)    The Pool shall be operational and may reinsure claims in accordance with this subtitle on or after July 1, 1994.    (c)    (1)    The reinsuring carriers shall elect a Board of Directors to be composed of seven members.        (2)    The Board shall include representation from carriers whose principal business in health insurance comprises small employers and, to the extent possible, at least one nonprofit health service plan, at least one commercial carrier, and at least one health maintenance organization.        (3)    A carrier, including its affiliates, may not be represented by more than one member on the Board.        (4)    The term of a member is 3 years except that the terms of initial members shall be staggered for periods of 1 to 3 years.        (5)    At the end of a term, a member continues to serve until a successor is elected.        (6)    Vacancies shall be filled by an election of the remaining Board members.        (7)    A member who is elected after a term has begun serves only for the rest of the term and until a successor is elected.        (8)    A member who serves two consecutive full 3–year terms may not be reelected for 3 years after the completion of those terms.    (d)    The Board shall choose a Chairman.    (e)    (1)    The Board shall appoint an Executive Director, who shall be the chief administrative officer of the Pool.        (2)    The Executive Director serves at the pleasure of the Board.        (3)    Under the direction of the Board, the Executive Director shall perform any duty or function that the Board requires.    (f)    The Pool may employ a staff in accordance with the budget of the Pool.    (g)    (1)    The Board shall submit to the Commissioner a plan of operation to ensure the fair, reasonable, and financially sound administration of the Pool.        (2)    The Commissioner may amend or rescind a plan of operation if the Commissioner finds that the Pool is not operating in a fair, reasonable, and financially sound manner.
MD. Insurance Code Ann. §  15-1217 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1217 - Requirements for Plan of Operation; Powers of Board

    (a)    At a minimum, the plan of operation shall:        (1)    establish procedures for the handling and accounting of Pool assets and money and for an annual fiscal report to the Commissioner;        (2)    establish procedures for reinsuring claims submitted to the Pool in accordance with this subtitle;        (3)    establish procedures for collecting assessments from members to reinsure claims submitted to the Pool and to pay for administrative expenses incurred or estimated to be incurred during the period;        (4)    establish procedures for recouping any net losses to the Pool for the calendar year by assessing reinsuring carriers under § 15–1221 of this subtitle; and        (5)    provide for any additional matters at the discretion of the Board.    (b)    The Board has the general powers and authority granted under the laws of the State to health insurers and health maintenance organizations authorized to transact business, except for the power to issue health benefit plans directly to groups or individuals.    (c)    The Board may:        (1)    enter into contracts as necessary or proper to carry out this subtitle and, with approval of the Commissioner, enter into contracts with similar programs of other states for the joint performance of common functions or with persons or other organizations for the performance of administrative functions;        (2)    sue or be sued;        (3)    take any legal action necessary or proper to recover assessments and penalties for, on behalf of, or against the Pool or reinsuring carriers or necessary to avoid the payment of improper claims against the Board;        (4)    define the health benefit plans and medical conditions for which claims may be reinsured with the Pool in accordance with this subtitle;        (5)    establish rules, conditions, and procedures that relate to reinsurance of claims by the Pool;        (6)    establish actuarial functions as appropriate for the operation of the Pool;        (7)    assess reinsuring carriers in accordance with the provisions of § 15–1221 of this subtitle;        (8)    make advance interim assessments as may be reasonable and necessary for organizational and interim operating expenses, to be credited against any assessments due after the close of the fiscal year;        (9)    appoint appropriate committees as necessary to provide technical assistance in the operation of the Pool, policy and other contract design, and any other function within the authority of the Pool; and        (10)    borrow money to carry out the purposes of the Pool.