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.