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Statutes Text

Article - Insurance




§15–1303.

    (a)    In addition to any other requirements under this article, a carrier that offers individual health benefit plans in this 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.