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Statutes Text

Article - Insurance




§31–103.

    (a)    The Exchange is subject to:

        (1)    the following provisions of the General Provisions Article:

            (i)    Title 3 (Open Meetings Act);

            (ii)    Title 4 (Public Information Act); and

            (iii)    Title 5 (Maryland Public Ethics Law);

        (2)    the following provisions of the State Finance and Procurement Article:

            (i)    Title 3A, Subtitle 3 (Information Processing), to the extent that the Secretary of Information Technology determines that an information technology project of the Exchange is a major information technology development project;

            (ii)    Title 12, Subtitle 4 (Policies and Procedures for Exempt Units); and

            (iii)    Title 14, Subtitle 3 (Minority Business Participation);

        (3)    the following provisions of the State Government Article:

            (i)    Title 10, Subtitle 1 (Administrative Procedure Act – Regulations); and

            (ii)    Title 12 (Immunity and Liability); and

        (4)    Title 5, Subtitle 3 of the State Personnel and Pensions Article.

    (b)    The Exchange is not subject to:

        (1)    taxation by the State or local government;

        (2)    Title 3A, Subtitle 3 (Information Processing), except to the extent determined by the Secretary of Information Technology under subsection (a)(1)(i) of this section;

        (3)    Division II of the State Finance and Procurement Article, except as provided in subsection (a)(1) of this section;

        (4)    Title 10 of the State Government Article, except as provided in subsection (a)(2)(i), (ii), and (iii) of this section;

        (5)    Division I of the State Personnel and Pensions Article, except as provided in subsection (a)(3) of this section and elsewhere in this title; or

        (6)    this article, except as provided in subsection (c) of this section and elsewhere in this title.

    (c)    (1)    Except as provided in paragraph (3) of this subsection, to the extent that the Exchange, acting on behalf of a carrier offering a qualified plan in the Individual Exchange or the SHOP Exchange, is required by law or contract to collect premiums, conduct billing, send required notices, provide required disclosures, or take any other action normally taken by a carrier under this article, the carrier is not liable or subject to regulatory sanction by the Commissioner for the failure of the Exchange to comply with the law or contract in taking an action under this subsection.

        (2)    (i)    Subject to subparagraph (ii) of this paragraph, the Commissioner shall regulate the Exchange in taking an action under this subsection.

            (ii)    If the Commissioner finds that the Exchange has failed to comply with the law or contract in taking an action under this subsection, the Commissioner:

                1.    may not impose a fine or an administrative penalty on the Exchange; and

                2.    may require the Exchange to:

                A.    make restitution, not to exceed the amount of actual economic damages sustained by the consumer, to a consumer who has sustained actual economic damages because of the failure of the Exchange to comply with the law or contract in taking an action; and

                B.    make restitution, not to exceed the amount of actual premium, premium subsidies, or cost–sharing subsidies the carrier did not receive, to a carrier that has authorized, provided, or paid for health care services without receiving premium, premium subsidies, or cost–sharing subsidies the carrier otherwise would have received but for the failure of the Exchange to comply with the law or contract in taking an action.

        (3)    (i)    The Exchange and the carrier shall hold a consumer harmless from any adverse consequence that is:

                1.    related to the consumer’s purchase of, or coverage under, a qualified plan; and

                2.    caused by the failure of the Exchange to comply with the law or contract in taking an action under this subsection.

            (ii)    Holding the consumer harmless shall include:

                1.    the extension of deadlines or other accommodations necessary to protect the consumer; and

                2.    the carrier’s authorization of, provision of, or payment for health care services the carrier otherwise would be under an obligation to authorize, provide, or pay for except for the failure of the Exchange to comply with the law or contract in taking an action under this subsection.

        (4)    The Commissioner, in the Commissioner’s role as a member of the Board, may not participate in any matter that involves the alleged failure of the Exchange to comply with the law or contract in taking an action under this subsection if, in the Commissioner’s judgment, the Commissioner’s participation might create a conflict of interest with respect to the Commissioner’s regulatory authority over the Exchange’s taking an action under this subsection.

    (d)    Except as provided in subsection (c) of this section, this section does not:

        (1)    affect the Commissioner’s authority to regulate a carrier under this article; or

        (2)    limit the authority of the Commissioner to take action against any person with respect to any provision of this article.