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Statutes Text

Article - Insurance




§31–113.1.

    (a)    In accordance with the requirement to operate a toll–free hotline under § 1311(d)(4) of the Affordable Care Act and § 31–108(b)(5) of this title, the Exchange may establish a Consolidated Services Center.

    (b)    (1)    The CSC may employ individuals to assist the SHOP Exchange.

        (2)    A CSC employee authorized to assist the SHOP Exchange:

            (i)    may provide the services set forth in § 31–112(c)(1) of this title, but may not initiate contact with a small employer for the purpose of soliciting the small employer to provide qualified plans offered by the SHOP Exchange to its employees;

            (ii)    shall hold a SHOP Exchange enrollment permit;

            (iii)    is not a SHOP Exchange navigator and may not hold a SHOP Exchange navigator license;

            (iv)    may not be required to hold an insurance producer license; and

            (v)    shall comply with the limitations set forth in § 31–112(c)(3) of this title.

        (3)    (i)    The Commissioner shall issue a SHOP Exchange enrollment permit to each applicant who meets the requirements of this paragraph.

            (ii)    To qualify for a SHOP Exchange enrollment permit, an applicant:

                1.    shall be of good character and trustworthy;

                2.    shall be at least 18 years old;

                3.    shall pass the written examination given by the Commissioner to applicants for a SHOP navigator license under § 31–112(d)(2)(iii) of this title;

                4.    shall be engaged by, and receive compensation only through, the CSC;

                5.    may not receive compensation from or otherwise be affiliated with a carrier, an insurance producer, a third–party administrator, or any other person connected to the insurance industry; and

                6.    shall complete, and comply with any ongoing requirements of, the training program established under § 31–112(h) of this title.

        (4)    The Commissioner’s duties and authority under § 31–112(d)(3) and (e) of this title shall apply to CSC employees who hold a SHOP Exchange enrollment permit issued under this subsection.

    (c)    (1)    The CSC may employ individuals to assist the Individual Exchange.

        (2)    A CSC employee authorized to assist the Individual Exchange:

            (i)    may provide the services set forth in § 31–113(d) of this title, but may not initiate contact with an individual for the purpose of soliciting the individual to enroll in a qualified plan offered by the Individual Exchange;

            (ii)    shall hold an Individual Exchange enrollment permit;

            (iii)    is not an Individual Exchange navigator and may not hold an Individual Exchange navigator certification;

            (iv)    may not be required to hold an insurance producer or adviser license;

            (v)    with respect to the insurance market outside the Exchange, shall comply with § 31–113(f)(8) of this title;

            (vi)    shall inquire whether an individual has health insurance obtained through an insurance producer and, if so, shall refer the individual to the insurance producer for information and services unless:

                1.    the individual is eligible for, but has not obtained a federal premium subsidy and cost–sharing assistance, and the insurance producer is not authorized to sell qualified plans in the Individual Exchange; or

                2.    the individual would prefer not to seek further assistance from the individual’s insurance producer; and

            (vii)    shall comply with all State and federal laws, regulations, and policies governing the Maryland Medical Assistance Program and the Maryland Children’s Health Program.

        (3)    (i)    The Exchange shall issue an Individual Exchange enrollment permit to each applicant who meets the requirements of this paragraph.

            (ii)    To qualify for an Individual Exchange enrollment permit, an applicant:

                1.    shall be of good character and trustworthy;

                2.    shall be at least 18 years old;

                3.    shall be engaged by, and receive compensation only through, the CSC;

                4.    may not receive any compensation, directly or indirectly, from:

                A.    a carrier, an insurance producer, or a third–party administrator in connection with the enrollment of a qualified individual in a qualified health plan; or

                B.    a managed care organization that participates in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children’s Health Program; and

                5.    shall complete, and comply with any ongoing requirements of, the training program established under § 31–113(k) of this title.

        (4)    The Commissioner’s duties and authority under § 31–113(l) of this title shall apply to CSC employees who hold an Individual Exchange enrollment permit issued under this subsection.

    (d)    The Exchange, the CSC, and CSC employees shall assist the Health Education and Advocacy Unit of the Office of the Attorney General in carrying out its duties to assist consumers under Title 13, Subtitle 4A of the Commercial Law Article and Title 15, Subtitles 10A and 10D of this article.