# Insurance (GIN)

## Title 15. Health Insurance

### Subtitle 12. Maryland Health Insurance Reform Act

#### Section 15-1204

(a) This section applies to a carrier with respect to any health benefit plan that is a grandfathered health plan, as defined in Sec. 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 Sec. 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.

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