reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans › Section 15-1104 - Limited Benefit Group Health Insurance Contracts

(a)    (1)    In this section the following words have the  meanings indicated.
(2)    “Employer sponsored health benefit plan” means any  plan, fund, or program that:
(i)    is established or maintained by an employer  under the Employee Retirement Income Security Act of 1974;
(ii)    offers coverage for health benefits; and
(iii)    is treated by the employer or any eligible employee or dependent as part of a plan, fund, or program under  the United States Internal Revenue Code, 26 U.S.C. § 106, § 125, or §  162.
(3)    “Group health insurance” has the meaning stated in § 15–302 of this title.
(4)    “Limited benefit group health insurance contract”  means a group health insurance contract that provides health  insurance benefits, but is not required to provide all the benefits  required under Subtitles 7 and 8 of this title.
(5)    “Special eligible employee” means an employee who:
(i)    is eligible for health coverage under the terms of an employer sponsored health benefit plan;
(ii)    works:
1.    on a temporary or substitute basis; or
2.    less than 30 hours in a normal workweek;  and
(iii)    is not eligible for coverage under any group health insurance contract, nonprofit health service plan  contract, or health maintenance organization contract issued to  the employee’s employer because the employee meets the criteria of item (ii) of this paragraph.
(b)    A limited benefit group health insurance contract may be  issued only by an insurer or nonprofit health service plan to an  employer if the limited group health insurance contract is issued  to provide health coverage only for:
(1)    special eligible employees; or
(2)    special eligible employees and their dependents.
(c)    An insurer or nonprofit health service plan that sells a limited benefit group health insurance contract, as a condition of  sale, may require the employer to:
(1)    collect payment for premiums due under the limited benefit group health insurance contract through payroll  deduction;
(2)    contribute to the premium payments applicable to  the coverage of a special eligible employee; and
(3)    offer coverage to any dependent of a special  eligible employee.
(d)    A limited benefit group health insurance contract shall  comply with:
(1)    this title, except Subtitles 7 and 8 of this title; and
(2)    notwithstanding item (1) of this subsection, §§ 15–802, 15–812, 15–815, 15–830, 15–831, 15–832, and 15–833 of this title.
(e)    An insurer or nonprofit health service plan shall  disclose in the group certificate and in enrollment material  provided to each special eligible employee that the limited benefit  group health insurance contract does not provide comprehensive  health coverage.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans › Section 15-1106 - Rescission of Health Benefit Plan

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan; or
(iii)    a health maintenance organization.
(3)    “Evidence of individual insurability” has the meaning stated in § 15–1105 of this subtitle.
(4)    “Health benefit plan” has the meaning stated in § 15–1301 of this title.
(b)    If a carrier conditions coverage for a health benefit plan on evidence of individual insurability, the carrier may not rescind a contract or a certificate on the basis of written information submitted on or with, or omitted from, an application for the health benefit plan unless the carrier completed medical underwriting and resolved all reasonable medical questions related to the written information submitted on or with, or omitted from, the application before issuing the health benefit plan.
(c)    The carrier shall have the burden of persuasion that its rescission of a health benefit plan complies with subsection (b) of this section.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 12 - Maryland Health Insurance Reform Act › Section 15-1202 - Scope of Subtitle

(a)    This subtitle applies only to a health benefit plan that:
(1)    covers eligible employees of small employers in the State; and
(2)    is issued or renewed on or after July 1, 1994, if:
(i)    any part of the premium or benefits is paid by or on behalf of the small employer;
(ii)    any eligible employee or dependent is reimbursed, through wage adjustments or otherwise, by or on behalf of the small employer for any part of the premium;
(iii)    the health benefit plan is treated by the employer or any eligible employee or dependent as part of a plan or program under the United States Internal Revenue Code, 26 U.S.C. § 106, § 125, or § 162; or
(iv)    the small employer allows eligible employees to pay for the health benefit plan through payroll deductions.
(b)    This subtitle applies to any health benefit plan offered by an association, a professional employer organization, or any other entity, including a plan issued under the laws of another state, if the health benefit plan covers eligible employees of one or more small employers and meets the requirements of subsection (a) of this section.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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).
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.