Section 15-1A-22 – Carriers May Refuse or Deny Coverage for Non-Discriminatory Reasons — Discrimination Based on Sexual Orientation or Gender Identity Prohibited
(a) (1) In this section the following words have the meanings indicated. (2) “Gender identity” has the meaning stated in § 20–101 of the State Government Article. (3) “Sexual orientation” has the meaning stated in § 20–101 of the State Government Article. (b) This section does not prohibit a carrier from refusing, withholding, or denying coverage under a health benefit […]
Section 15-1A-14 – Emergency Services — Coverages
(a) (1) In this section the following words have the meanings indicated. (2) “Emergency medical condition” means a medical condition that manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result […]
Section 15-1A-15 – Summary of Benefits and Coverage Explanation — Regulations by Commissioner — Uniform Definitions — Periodic Review
(a) This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan. (b) (1) A carrier shall compile and provide to consumers a summary of benefits and coverage explanation that: (i) accurately describes the benefits and coverage under the applicable health benefit plan; and (ii) except as provided in paragraph (2) of […]
Section 15-1A-16 – Acceptable Medical Loss Ratio — Calculation
(a) (1) For purposes of this section, “medical loss ratio”: (i) has the meaning established in 45 C.F.R. § 158.221; or (ii) if the Commissioner adopts regulations as described in paragraph (2) of this subsection, has the meaning established by the adopted regulations. (2) To the extent necessary, the Commissioner shall adopt regulations that: (i) establish a definition for “medical loss […]
Section 15-1A-17 – Required Information Provided by Carrier — Disclosures — Hardship Exemptions — Catastrophic Plans
(a) (1) This section may not be construed to require a carrier to disclose information that is proprietary and trade secret information under applicable law. (2) This section applies only to carriers offering an individual plan or a small group plan. (b) A carrier shall disclose to an individual or employer, as applicable, the following information: (1) the carrier’s right […]
Section 15-1A-18 – Catastrophic Plans — Regulations Governing
(a) A carrier may offer a catastrophic plan in the individual market in accordance with the requirements of this section. (b) A catastrophic plan may be offered only to individuals who: (1) are under the age of 30 years before the beginning of the plan year; or (2) hold certification for a hardship exemption or an affordability exemption as […]
Section 15-1A-19 – Annual Limitations on Cost Sharing for Essential Health Benefits Covered — Regulations
(a) (1) In this section, “cost–sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits. (2) “Cost–sharing” includes: (i) deductibles, coinsurance, copayments, or similar charges; and (ii) any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to […]
Section 15-1A-20 – Prescription Drug Essential Health Benefits for Individual and Small Group Plans
(a) (1) This section applies only to individual plans and small group plans. (2) The requirements in this section are in addition to and not in substitution of any other requirements of law related to prescription drug benefits. (b) (1) Except as provided in paragraph (2) of this subsection, an individual plan or a small group plan shall be considered […]
Section 15-1A-21 – Rescission of Coverage Under Health Benefit Plans — Exceptions
(a) This section applies to all grandfathered plans and to every health benefit plan that is not a grandfathered plan. (b) (1) Subject to § 15–1106 of this title, a carrier may not rescind the coverage under a health benefit plan unless: (i) the insured individual performs an act, a practice, or an omission that constitutes fraud or makes […]
Section 15-1A-06 – Certain Factors Prohibited in Consideration — Extra Premiums Prohibited
(a) A carrier may not establish rules for eligibility, including continued eligibility, for enrollment of an individual into a health benefit plan based on health status–related factors, including: (1) health condition; (2) claims experience; (3) receipt of health care; (4) medical history; (5) genetic information; (6) evidence of insurability including conditions arising out of acts of domestic violence; or (7) disability. (b) A carrier […]