# Insurance (GIN)

## Title 11. Insurance Rating Law

### Subtitle 6. Health Benefit Plan Premium Rate Review

#### Section 11-601

(a) In this subtitle the following words have the meanings indicated.

(b) "Carrier" means a person that:

  (1) offers a health benefit plan in the State; and

  (2) is:

    (i) an insurer;

    (ii) a nonprofit health service plan; or

    (iii) a health maintenance organization.

(c) "Contract holder" means a person to which a carrier has issued a health benefit plan.

(d)

  (1) "Health benefit plan" means:

    (i) a health insurance contract, a nonprofit health service plan contract, or a health maintenance organization contract that includes benefits for medical care; or

    (ii) a certificate of health insurance issued or delivered to a Maryland resident under a contract issued to an association located in the State or any other state.

  (2) "Health benefit plan" does not include:

    (i) one or more, or any combination of the following:

      (1) coverage only for accident or disability income insurance;

      (2) coverage issued as a supplement to liability insurance;

      (3) liability insurance, including general liability insurance and automobile liability insurance;

      (4) workers' compensation or similar insurance;

      (5) automobile medical payment insurance;

      (6) credit-only insurance;

      (7) coverage for on-site medical clinics; and

      (8) other similar insurance coverage, as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits;

    (ii) the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of a health benefit plan:

      (1) limited scope dental or vision benefits;

      (2) benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these benefits; and

      (3) other similar limited benefits as specified in federal regulations issued pursuant to P.L. 104-191;

    (iii) the following benefits if offered as independent, noncoordinated benefits:

      (1) coverage only for a specified disease or illness; and

      (2) hospital indemnity or other fixed indemnity insurance; or

    (iv) the following benefits if offered as a separate policy, certificate, or contract of insurance:

      (1) Medicare supplemental health insurance, as defined in Sec. 1882(g)(1) of the Social Security Act;

      (2) coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and

      (3) similar supplemental coverage provided to coverage under an employer sponsored plan.

(e) "Medical care" means:

  (1) items or services for the diagnosis, cure, mitigation, treatment, or prevention of a disease, injury, or condition affecting any structure or function of the body; and

  (2) transportation primarily for and essential to medical care described in item (1) of this subsection.

#### Section 11-602

This subtitle applies to a carrier that issues or delivers a health benefit plan in the State.

#### Section 11-603

(a) A carrier subject to this subtitle may not charge a premium to a contract holder or to an individual covered under a health benefit plan before the applicable premium rate is filed with and approved by the Commissioner.

(b) A carrier subject to this subtitle may not change the premium charged to a contract holder or to an individual covered under a health benefit plan until the applicable premium rate change has been filed with and approved by the Commissioner.

(c)

  (1) Any applicable premium rate or premium rate change of a carrier subject to this subtitle shall be filed with the Commissioner:

    (i) for insurers, in accordance with Sec. 12-203 of this article and regulations adopted under Title 31, Subtitle 10 of the Code of Maryland Regulations;

    (ii) for nonprofit health service plans, in accordance with Sec. 14-126 of this article; and

    (iii) for health maintenance organizations, in accordance with Sec. 19-713 of the Health - General Article and regulations adopted under Title 31, Subtitle 12 of the Code of Maryland Regulations.

  (2)

    (i) The Commissioner shall disapprove or modify a proposed premium rate filing if the proposed premium rates appear, based on statistical analysis and reasonable assumptions, to be inadequate, unfairly discriminatory, or excessive in relation to benefits.

    (ii) In determining whether to disapprove or modify a premium rate filing of a carrier, the Commissioner shall consider, to the extent appropriate:

      (1) past and prospective loss experience in and outside the State;

      (2) underwriting practice and judgment;

      (3) a reasonable margin for reserve needs;

      (4) past and prospective expenses, both countrywide and those specifically applicable to the State; and

      (5) any other relevant factors in and outside the State.

  (3)

    (i) Each premium rate filing and any supporting information filed under this subtitle shall be open to public inspection as soon as filed.

    (ii) A carrier may request a finding by the Commissioner that certain information filed with the Commissioner be considered confidential commercial information under  Sec. 4-335 of the General Provisions Article and not subject to public inspection.

    (iii) On request and payment of a reasonable fee, a person may obtain copies of a premium rate filing and any supporting information.

(d) Notwithstanding the Commissioner's previous approval of a premium rate filing of a carrier subject to this section, the Commissioner, at any time, may require the carrier to demonstrate that, based on statistical analysis and reasonable assumptions and considering the factors listed in subsection (c)(2) of this section, its premium rates for a health benefit plan are not inadequate, unfairly discriminatory, or excessive in relation to benefits.

(e)

  (1) If, after the applicable review period, the Commissioner finds that the premium rates in a premium rate filing of a carrier subject to this section are inadequate, unfairly discriminatory, or excessive, as determined under subsection (c)(2) of this section, the Commissioner shall issue to the carrier an order that:

    (i) specifies the reasons why the premium rate filing is inadequate, unfairly discriminatory, or excessive in relation to benefits under subsection (c)(2) of this section; and

    (ii) states when, within a reasonable period after the order, the premium rate filing will no longer be effective.

  (2)

    (i) The Commissioner shall hold a hearing before issuing an order under paragraph (1) of this subsection.

    (ii) The Commissioner shall give written notice of the hearing to the carrier at least 10 days before the hearing.

    (iii) The written notice shall specify the matters to be considered at the hearing.

  (3) An order issued under paragraph (1) of this subsection does not affect a health benefit plan issued or delivered before the expiration of the period stated in the order.

(f) Each decision or finding of the Commissioner about premium rates made under this subtitle is subject to judicial review in accordance with Subtitle 5 of this title.

#### Section 11-604

A carrier shall provide notice annually to its insureds and enrollees, and post a notice on the carrier's Web site, that an insured or enrollee may access information about proposed rate increases and submit comments regarding proposed rate increases on the Administration's Web site. 

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Md. Code Ann., Ins. (as displayed at mgaleg.maryland.gov, October 16, 2026)