Current with changes from the 2024 Legislative Session
Section 15-1204 - Requirements and limitations for carriers(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 types of administrative personnel;(2) have a satisfactory grievance procedure and ability to respond to enrollees' calls, questions, and complaints;(3) provide, in the case of individuals covered under more than one health benefit plan, for coordination of coverage under all of those health benefit plans in an equitable manner; and(4) design policies to help ensure adequate access to providers of health care.(c) A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.(d) A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.(e) A carrier may offer benefits in addition to those in the Standard Plan if: (1) the additional benefits: (i) are offered and priced separately from benefits specified in accordance with § 15-1207 of this subtitle; and(ii) do not have the effect of duplicating any of those benefits; and(2) the carrier: (i) clearly distinguishes the Standard Plan from other offerings of the carrier;(ii) indicates the Standard Plan is the only plan required by State law; and(iii) specifies that all enhancements to the Standard Plan are not required by State law.(f) Notwithstanding subsection (c) of this section, a health maintenance organization may provide a point of service delivery system as an additional benefit through another carrier regardless of whether the other carrier also offers the Standard Plan.(g) A carrier may offer coverage for dental care and services as an additional benefit.(h)(1) In this subsection, "prominent carrier" means a carrier that insures at least 10% of the total lives insured in the small group market.(2)(i) A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.(ii) A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.(3) A carrier may not condition the sale of a wellness benefit to a small employer on participation of the eligible employees of the small employer in wellness programs or activities.