Section 15-1A-02 – Enforcement of Provisions by Commissioner
(a) The Commissioner may enforce: (1) the provisions of this subtitle; and (2) notwithstanding any other provisions of law, the following provisions of Title 1, Subtitles A, C, and D of the Affordable Care Act as they apply to individual health insurance coverage and health insurance coverage offered in the small group and large group markets as those […]
Section 15-1A-03 – Adoption of Regulations — Application to Health Benefit Plan — Grandfathered Plans
(a) For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that: (1) establish criteria that a health benefit plan must meet to be considered a grandfathered plan; and (2) are consistent with 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019. (b) Except […]
Section 15-1A-04 – Criteria for Health Benefit Plans — Consistent With Federal Law
For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that: (1) establish criteria that a health benefit plan must meet to be considered a health benefit plan that covers essential health benefits; and (2) are consistent with 45 C.F.R. Part 156 Subpart B and any corresponding federal rules and guidance as those […]
Section 15-1A-05 – Application to Grandfathered Plans — Prohibition on Certain Exclusions or Denials
(a) This section applies to all grandfathered plans except grandfathered plans that are individual plans and to every health benefit plan that is not a grandfathered plan. (b) A carrier may not: (1) exclude or limit benefits because a health condition was present before the effective date of coverage; or (2) deny coverage because a health condition was present […]
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 […]
Section 15-1A-07 – Premium Rates Review — Basis — Ratio of Premium Rate Variation
(a) (1) This section may not be construed to limit the authority of the Commissioner to conduct a health benefit plan premium rate review under Title 11, Subtitle 6 of this article. (2) This section applies only to a carrier offering an individual plan and, subject to § 15–1205 of this title, a carrier offering a small group […]
Section 15-1A-08 – Coverage Available for Dependent Child Until Age of 26 Years — Relationship to Insured
(a) A carrier that offers a health benefit plan, including a grandfathered plan, that provides for dependent coverage of a child shall continue to make the coverage available for the child until the child is 26 years old. (b) A carrier may not establish rules for eligibility, including continued eligibility, for coverage of a child under the […]
Section 15-1A-09 – Acceptance of All Employers and Individuals — Exceptions
(a) Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article: (1) Subtitle 4 of this title; (2) §§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title; (3) §§ 15–1316 and […]
Section 15-1A-10 – Coverages Required and Additional Charges Prohibited — Out-of-Network Charges — Services Recommended or Not by Task Force
(a) Except as provided in subsections (b) and (c) of this section, a carrier shall provide coverage for and may not impose any cost–sharing requirements, including copayments, coinsurance, or deductibles for: (1) evidence–based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task […]
Section 15-1A-11 – Lifetime or Annual Limits on Benefits
(a) Except as provided in subsections (b) and (c) of this section, a carrier that offers a health benefit plan, including a grandfathered plan, may not establish lifetime limits or annual limits on the dollar value of benefits for any insured individual. (b) To the extent that limits are otherwise authorized under federal or State law, a […]