Maryland Insurance Section 15-1204
§ 15-1204.
CAUTION: READ FULL TEXT OF SECTION FOR SPECIAL NOTE
(a) 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.
(b) A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.
(c) Except for the Limited Benefit Plan, a carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.
(d) 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.
(e) Notwithstanding subsection (b) 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.
(f) A carrier may offer coverage for dental care and services as an additional benefit.
// SPECIAL NOTE: THE ABOVE SECTION WAS CHANGED BY CHAPTER 287 OF 2004 AND WILL REMAIN IN EFFECT UNTIL JUNE 30, 2008 //
(a) 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.
(b) A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.
(c) A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.
(d) 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.
(e) Notwithstanding subsection (b) 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.
(f) A carrier may offer coverage for dental care and services as an additional benefit.
