Maryland Insurance Section 14-512

CAUTION: READ FULL TEXT OF SECTION FOR SPECIAL NOTE

      (a)      The Program shall:

            (1)      subject to the moneys available in the segregated account under § 14-504 of this subtitle, provide benefits to the maximum number of individuals eligible for enrollment in the Program;

            (2)      require a monthly premium charge of $10 per enrollee;

            (3)      not require a deductible; and

            (4)      limit the copay charged an enrollee to:

                  (i)      $10 for a prescription for a generic drug;

                  (ii)      $20 for a prescription for a preferred brand name drug; and

                  (iii)      $35 for a prescription for a nonpreferred brand name drug.

      (b)      The Board may limit the total annual benefit to $1,000 per individual.

      (c)      Subject to approval by the Board, the carrier that administers the Program shall develop a prescription drug formulary to be used in the Program.

// SPECIAL NOTE: THE ABOVE SECTION WAS CHANGED BY CHAPTERS 281 AND 282 OF 2005 AND WILL REMAIN IN EFFECT UNTIL JUNE 30, 2007 //

** SPECIAL NOTE: CONTINGENCY - CHAPTERS 281 AND 282 - 2005 **

      (a)      The Program shall:

            (1)      subject to the moneys available in the segregated account under § 14-504 of this subtitle, provide benefits to the maximum number of individuals eligible for enrollment in the Program; and

            (2)      provide a State subsidy for a portion of the cost of Medicare Part D and Medicare Advantage Plan drug-related premiums and deductibles.

      (b)      The subsidy required under subsection (a) of this section shall be equal to:

            (1)      for the Medicare Part D prescription drug plan or Medicare Advantage Plan drug-related premium:

                  (i)      for individuals who do not qualify for a federal low-income subsidy, at least $25 per enrollee per month; and

                  (ii)      for individuals who qualify for a partial federal low-income subsidy, the lesser of:

                        1.      the amount provided under item (i) of this item; or

                        2.      the full amount of the enrollee share of the premium; and

            (2)      for the Medicare Part D prescription drug plan or Medicare Advantage Plan drug-related deductible, the total amount of the deductible, less the copayment or coinsurance amount specified in subsection (c) of this section.

      (c)      An enrollee shall pay a copayment or coinsurance amount, instead of a deductible, equal to the initial copayment or coinsurance amount for which the enrollee is responsible under the enrollee's Medicare Part D prescription drug plan or Medicare Advantage Plan after the deductible is satisfied.

      (d)      The Program shall establish an annual subsidy limit for an enrollee.