(a) In this subtitle the following words have the meanings indicated. (b) “Carrier” means: (1) an insurer that holds a certificate of authority in the State and provides health insurance in the State; (2) a health maintenance organization that is licensed to operate in the State; (3) a nonprofit health service plan that is licensed to operate in the State; […]
(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 […]
(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 […]
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 […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
A carrier offering a group plan, including a grandfathered plan, may not apply a waiting period of more than 90 days that must pass before coverage becomes effective for an individual who is otherwise eligible for the group plan.
(a) If a carrier requires or provides for the designation of a participating primary care provider for an insured individual, the carrier shall allow each insured individual to designate any participating primary care provider if the provider is available to accept the insured individual. (b) (1) (i) This subsection applies only to an individual who has a child who […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
(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 […]
