(a) In this subtitle the following words have the meanings indicated. (b) “Board” means the Board of Directors of the Pool established under § 15–1216 of this subtitle. (c) “Carrier” means a person that: (1) offers health benefit plans in the State covering eligible employees of small employers; and (2) is: (i) an authorized insurer that provides health insurance in the […]
(a) This subtitle applies only to a health benefit plan that: (1) covers eligible employees of small employers in the State; and (2) is issued or renewed on or after July 1, 1994, if: (i) any part of the premium or benefits is paid by or on behalf of the small employer; (ii) any eligible employee or dependent is reimbursed, […]
(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 […]
(a) This section applies to a carrier with respect to any health benefit plan that: (1) is not a grandfathered health plan, as defined in § 1251 of the Affordable Care Act; and (2) is issued, delivered, or renewed in the State on or after January 1, 2014. (b) (1) Except as provided in this subsection and § 31–110(f) of […]
(a) (1) This subsection 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. (2) In establishing a community rate for a health benefit plan, a carrier shall use a rating methodology that is based on the experience of all risks […]
(a) (1) A carrier may not arbitrarily transfer a small employer involuntarily into or out of a health benefit plan. (2) A carrier may not offer to transfer a small employer into or out of a health benefit plan unless the offer to transfer is made to all small employers with similar risk adjustment factors. (b) A carrier shall […]
(a) In accordance with Title 19, Subtitle 1 of the Health – General Article, the Commission shall adopt regulations that specify: (1) the Comprehensive Standard Health Benefit Plan to apply under this subtitle; and (2) the requirements for a wellness benefit offered by a carrier to apply under this subtitle. (b) (1) Subject to paragraph (2) of this subsection, the […]
The provisions of § 15–508 of this title apply to a policy or certificate issued to a small employer.
(a) A carrier shall provide the special enrollment periods described in this section in each small employer health benefit plan. (b) A carrier shall allow an eligible employee or dependent who is eligible, but not enrolled, for coverage under the terms of the employer’s health benefit plan to enroll for coverage under the terms of the plan […]
(a) (1) In this section the following words have the meanings indicated. (2) “Dependent” means an individual who is or who may become eligible for coverage under the terms of a health benefit plan because of a relationship with an eligible employee. (3) “Qualifying coverage in an eligible employer–sponsored plan” has the meaning stated in 45 C.F.R. § 155.300. […]
(a) This section does not apply to any insurance enumerated in § 15–1201(i)(3)(i) through (xiii) of this subtitle. (b) A carrier shall issue its health benefit plans to each small employer that meets the requirements of this section. (c) (1) Nothing in this subsection requires a small employer to contribute to the premium payments for coverage of a dependent […]
(a) A carrier that offers coverage to a small employer shall: (1) offer coverage to all of its eligible employees and all of their eligible dependents; and (2) at the election of the small employer, offer coverage to all of its part–time employees who have a normal workweek of at least 17 1/2 but less than 30 hours […]
(a) To sell health benefit plans to small employers in the State, a carrier shall file its proposed health benefit plans with the Commissioner on or before the date designated by the Commissioner. (b) Unless the Commissioner previously has disapproved a health benefit plan, it is deemed approved 60 days after filing with the Commissioner.
(a) (1) In this section the following words have the meanings indicated. (2) “Plan” means, with respect to a product, the pairing of the health benefits under the product with a particular cost–sharing structure, provider network, and service area. (3) (i) “Product” means a discrete package of health benefits that are offered using a particular product network type within a […]
(a) This section does not apply to any insurance enumerated in § 15–1201(i)(3)(i) through (xiii) of this subtitle. (b) Each benefit offered in addition to the Standard Plan that increases access to care choices or lowers the cost–sharing arrangement in the Standard Plan is subject to all of the provisions of this subtitle applicable to the Standard […]
Notwithstanding any other provision of this subtitle, health benefit plans shall reimburse hospitals in accordance with rates approved by the State Health Services Cost Review Commission.
(a) (1) Each carrier shall elect to become either a risk-assuming carrier or reinsuring carrier. (2) The notification of election to become a risk-assuming carrier shall include an appropriate opinion by an independent qualified actuary that the risk-assuming carrier is able to assume and manage the risk of enrolling groups under this subtitle without the protection of the […]
(a) The Commissioner shall establish the Maryland Small Employer Health Reinsurance Pool. (b) The Pool shall be operational and may reinsure claims in accordance with this subtitle on or after July 1, 1994. (c) (1) The reinsuring carriers shall elect a Board of Directors to be composed of seven members. (2) The Board shall include representation from carriers whose principal […]
(a) At a minimum, the plan of operation shall: (1) establish procedures for the handling and accounting of Pool assets and money and for an annual fiscal report to the Commissioner; (2) establish procedures for reinsuring claims submitted to the Pool in accordance with this subtitle; (3) establish procedures for collecting assessments from members to reinsure claims submitted to […]
(a) A reinsuring carrier may reinsure with the Pool as provided in this section. (b) At a minimum, the Pool shall reinsure up to the level of coverage specified under the Standard Plan. (c) A reinsuring carrier may reinsure an entire employer group within 60 days after commencement of the group’s coverage under a health benefit plan. (d) (1) A […]
