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<section article="gin" article_name="Insurance" number="14-115" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Board” means the board of directors of a nonprofit health service plan.</text>
    </level>
    <level label="3">
      <text>“Immediate family member” means a spouse, child, child’s spouse, parent, spouse’s parent, sibling, or sibling’s spouse.</text>
    </level>
  </level>
  <level label="b">
    <text>This section applies to a nonprofit health service plan that is:</text>
    <level label="1">
      <text>issued a certificate of authority in the State; and</text>
    </level>
    <level label="2">
      <text>organized under the laws of the State.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>The business and affairs of a nonprofit health service plan shall be managed under the direction of a board of directors.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>The board and its individual members are fiduciaries and shall act:</text>
        <level label="1">
          <text>in good faith;</text>
        </level>
        <level label="2">
          <text>in a manner that is reasonably believed to be in the best interests of the corporation and its controlled affiliates or subsidiaries that offer health benefit plans;</text>
        </level>
        <level label="3">
          <text>in a manner that is reasonably believed to be in furtherance of the mission of the corporation as a nonprofit health service plan as required under § 14-102(c) of this subtitle; and</text>
        </level>
        <level label="4">
          <text>with the care that an ordinarily prudent person in a like position would use under similar circumstances.</text>
        </level>
      </level>
      <level label="ii">
        <text>The board and its individual members may not use board membership for personal or financial enrichment to the detriment of the nonprofit health service plan or the mission of the nonprofit health service plan.</text>
      </level>
    </level>
    <level label="3">
      <text>The principal functions of the board shall include:</text>
      <level label="i">
        <text>ensuring that the corporation effectively carries out the nonprofit mission established under § 14-102(c) of this subtitle;</text>
      </level>
      <level label="ii">
        <text>selecting corporate management and evaluating its performance;</text>
      </level>
      <level label="iii">
        <text>ensuring to the extent practicable that human resources and other resources are sufficient to meet corporate objectives;</text>
      </level>
      <level label="iv">
        <text>subject to the provisions of subsection (d) of this section, nominating and selecting suitable candidates for the board;</text>
      </level>
      <level label="v">
        <text>establishing a system of governance at the board level, including an annual evaluation of board performance; and</text>
      </level>
      <level label="vi">
        <text>before considering any bid or offer to acquire the nonprofit health service plan and to convert to a for-profit entity under Title 6.5 of the State Government Article, ensuring that adequate consideration is given to an independent valuation of the nonprofit health service plan.</text>
      </level>
    </level>
    <level label="4">
      <text>Each member of the board shall demonstrate a commitment to the mission of the nonprofit health service plan as required by § 14-102(c) of this subtitle.</text>
    </level>
    <level label="5">
      <text>An officer or employee of a nonprofit health service plan or any of its affiliates or subsidiaries may not be appointed or elected to the board.</text>
    </level>
    <level label="6">
      <text>A nonprofit health service plan is subject to the provisions of § 2-419 of the Corporations and Associations Article.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>This subsection applies to a corporation that is:</text>
      <level label="i">
        <text>issued a certificate of authority as a nonprofit health service plan; and</text>
      </level>
      <level label="ii">
        <text>the sole member of a corporation issued a certificate of authority as a nonprofit health service plan.</text>
      </level>
    </level>
    <level label="2">
      <text>The board shall be composed of at least 11 members and no more than 23 members, including:</text>
      <level label="i">
        <text>one nonvoting member, who is not a member of the Maryland General Assembly, appointed by and serving at the pleasure of the President of the Senate of Maryland;</text>
      </level>
      <level label="ii">
        <text>one nonvoting member, who is not a member of the Maryland General Assembly, appointed by and serving at the pleasure of the Speaker of the House of Delegates; and</text>
      </level>
      <level label="iii">
        <text>no more than 21 voting members selected by the board, in accordance with the bylaws of the corporation, including three consumer members, who are covered by the nonprofit health service plan or its affiliates at the time of their initial election to the board and who satisfy the requirements of paragraphs (13), (14), and (15) of this subsection.</text>
      </level>
    </level>
    <level label="3">
      <text>No more than five members of the board may be:</text>
      <level label="i">
        <text>licensed health care professionals;</text>
      </level>
      <level label="ii">
        <text>hospital administrators; or</text>
      </level>
      <level label="iii">
        <text>employees of health care professionals or hospitals.</text>
      </level>
    </level>
    <level label="4">
      <text>To the extent possible, the board shall seek to include individuals with a diverse range of experience relevant to the mission of the corporation as a nonprofit health service plan as required under § 14–102 of this subtitle, including experience in data, consumer experience, government programs, population health, geriatrics, diversity, equity and inclusion, audit, human resources, benefit consulting, executive level, actuarial, accounting, information technology, finance, law, large and small businesses, nonprofit businesses, and organized labor.</text>
    </level>
    <level label="5">
      <text>Except for nonvoting members under paragraph (2)(i) and (ii) of this subsection, the board shall be self–perpetuating.</text>
    </level>
    <level label="6">
      <text>The board shall have the following standing committees whose duties shall include:</text>
      <level label="i">
        <text>an audit committee responsible for ensuring financial accountability;</text>
      </level>
      <level label="ii">
        <text>a finance committee responsible for reviewing and making recommendations on the annual budget and for developing and recommending long–range financial objectives;</text>
      </level>
      <level label="iii">
        <text>a compensation committee responsible for developing proposed compensation guidelines in accordance with § 14–139(d) of this subtitle;</text>
      </level>
      <level label="iv">
        <text>a nominating committee responsible for identifying, evaluating, and recommending to the board individuals qualified to become board members, including individuals who represent a corporation for which the nonprofit health service plan is the sole member;</text>
      </level>
      <level label="v">
        <text>a service and quality oversight committee responsible for ensuring that policies and processes are in effect to assess and improve the quality of health insurance products provided to subscribers and certificate holders;</text>
      </level>
      <level label="vi">
        <text>a mission oversight committee responsible for ensuring that the officers of the corporation act in accordance with the mission of the nonprofit health service plan;</text>
      </level>
      <level label="vii">
        <text>a strategic planning committee responsible for examining long–range planning objectives, assessing strategies that may be used to implement the planning objectives, and analyzing the nonprofit health service plan’s role in the insurance marketplace; and</text>
      </level>
      <level label="viii">
        <text>any other committee that the board determines is necessary to carry out its duties.</text>
      </level>
    </level>
    <level label="7">
      <text>Each standing committee shall have representation from:</text>
      <level label="i">
        <text>the voting members under paragraph (2) of this subsection; and</text>
      </level>
      <level label="ii">
        <text>each corporation for which the nonprofit health service plan is the sole member.</text>
      </level>
    </level>
    <level label="8">
      <text>The compensation committee and the nominating committee shall each include either the appointee of the President of the Senate or the appointee of the Speaker of the House of Delegates.</text>
    </level>
    <level label="9">
      <text>Each board member shall serve on at least one standing committee.</text>
    </level>
    <level label="10">
      <text>The chairman of the board shall select a chairman for each board committee.</text>
    </level>
    <level label="11">
      <level label="i">
        <text>The board shall approve in advance any action by the nonprofit health service plan, a corporation for which the plan is the sole member, or any affiliate or subsidiary of the nonprofit health service plan to:</text>
        <level label="1">
          <text>materially modify options available in benefit plans marketed in the State;</text>
        </level>
        <level label="2">
          <text>materially modify Maryland provider networks or Maryland provider reimbursement levels;</text>
        </level>
        <level label="3">
          <text>materially modify underwriting guidelines for products marketed in the State;</text>
        </level>
        <level label="4">
          <text>materially modify rates or rating plans that are required to be approved by the Commissioner;</text>
        </level>
        <level label="5">
          <text>add a product to or withdraw a product from the Maryland market, withdraw from a line or type of business in the State, or withdraw from a geographic region in the State;</text>
        </level>
        <level label="6">
          <text>materially modify marketing goals and objectives in the State; or</text>
        </level>
        <level label="7">
          <text>materially impact the availability or affordability of health care in the State.</text>
        </level>
      </level>
      <level label="ii">
        <text>The Commissioner shall adopt regulations that define “material” for purposes of subparagraph (i) of this paragraph.</text>
      </level>
      <level label="iii">
        <text>A decision by the board to convert to a for–profit entity under Title 6.5 of the State Government Article may be rejected by any three members of the board.</text>
      </level>
      <level label="iv">
        <text>The board may delegate approval for the actions listed in subparagraph (i) of this paragraph to a standing committee of the board.</text>
      </level>
    </level>
    <level label="12">
      <text>The board shall take and retain complete minutes of all board and committee meetings.</text>
    </level>
    <level label="13">
      <text>The three consumer members shall be either subscribers or certificate holders of the nonprofit health service plan or its affiliates at the time of their initial election to the board.</text>
    </level>
    <level label="14">
      <text>Each consumer member of the board:</text>
      <level label="i">
        <text>shall be a member of the general public;</text>
      </level>
      <level label="ii">
        <text>may not be considered an agent or employee of the State for any purpose; and</text>
      </level>
      <level label="iii">
        <text>is entitled to the same rights, powers, and privileges as the other members of the board.</text>
      </level>
    </level>
    <level label="15">
      <text>A consumer member of the board may not:</text>
      <level label="i">
        <text>be a licensee of or otherwise be subject to regulation by the Commissioner;</text>
      </level>
      <level label="ii">
        <text>be employed by or have a financial interest in:</text>
        <level label="1">
          <text>a nonprofit health service plan or its affiliates or subsidiaries; or</text>
        </level>
        <level label="2">
          <text>a person regulated under this article or the Health – General Article; or</text>
        </level>
      </level>
      <level label="iii">
        <text>within 3 years before appointment, have been employed by, had a financial interest in, or have received compensation from:</text>
        <level label="1">
          <text>a nonprofit health service plan or its affiliates or subsidiaries; or</text>
        </level>
        <level label="2">
          <text>a person regulated under this article or the Health – General Article.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>This subsection does not apply to a board that has fewer than three authorized members.</text>
    </level>
    <level label="2">
      <text>The term of a member is 3 years.</text>
    </level>
    <level label="3">
      <text>The terms of the members of a board shall be staggered over a 3–year period as required by the terms provided for members of the board in the bylaws filed and approved by the Commissioner on or after June 1, 2003.</text>
    </level>
    <level label="4">
      <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text>
    </level>
    <level label="5">
      <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text>
    </level>
    <level label="6">
      <text>A member may not serve for more than:</text>
      <level label="i">
        <text>three  full terms; or</text>
      </level>
      <level label="ii">
        <text>a total of more than 9 years.</text>
      </level>
    </level>
    <level label="7">
      <text>A person may not be a member of the board if the person:</text>
      <level label="i">
        <text>has defaulted on the payment of a monetary obligation to the nonprofit health service plan;</text>
      </level>
      <level label="ii">
        <text>has been convicted of a criminal offense involving dishonesty or breach of trust or a felony;</text>
      </level>
      <level label="iii">
        <text>habitually has neglected to pay debts; or</text>
      </level>
      <level label="iv">
        <text>has been prohibited under any federal securities law from acting as a director or officer of any corporation.</text>
      </level>
    </level>
    <level label="8">
      <text>A member shall meet any other qualifications set forth in the bylaws of the nonprofit health service plan.</text>
    </level>
    <level label="9">
      <text>A member may not be an immediate family member of another board member or an officer or employee of the nonprofit health service plan.</text>
    </level>
    <level label="10">
      <text>The board shall elect a chairman from among its members.</text>
    </level>
    <level label="11">
      <level label="i">
        <text>The composition of the board shall represent the racial and gender diversity of the State.</text>
      </level>
      <level label="ii">
        <text>The board shall include representation from each geographic region of the State.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>The board shall notify the Commissioner of any member who attends less than 65% of the meetings of the board during a period of 12 consecutive months.</text>
  </level>
  <level label="g">
    <level label="1">
      <text>Board members may receive the following compensation:</text>
      <level label="i">
        <text>reimbursement for ordinary and necessary expenses; and</text>
      </level>
      <level label="ii">
        <text>an amount of base compensation and compensation for attendance at meetings in accordance with § 14–139 of this subtitle.</text>
      </level>
    </level>
    <level label="2">
      <text>A board member may not receive more than the amount specified in paragraph (1) of this subsection for serving on more than one board of a corporation subject to this section.</text>
    </level>
    <level label="3">
      <level label="i">
        <text>This paragraph applies to a corporation that is:</text>
        <level label="1">
          <text>issued a certificate of authority as a nonprofit health service plan; and</text>
        </level>
        <level label="2">
          <text>the sole member of a corporation issued a certificate of authority as a nonprofit health service plan.</text>
        </level>
      </level>
      <level label="ii">
        <text>On or before June 30 of each calendar year, a corporation subject to this paragraph shall report to the Commissioner on:</text>
        <level label="1">
          <text>the total amount of base compensation, compensation for attendance at meetings, and reimbursement for ordinary and necessary expenses paid to each board member in the preceding calendar year; and</text>
        </level>
        <level label="2">
          <text>the proposed annual compensation, together with necessary supporting documentation, to be paid to board members for the next calendar year.</text>
        </level>
      </level>
    </level>
  </level>
</section>
