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<section article="gin" article_name="Insurance" number="15-1204" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <text>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.</text>
  </level>
  <level label="b">
    <text>In addition to any other requirement under this article, a carrier shall:</text>
    <level label="1">
      <text>have demonstrated the capacity to administer the health benefit plan, including adequate numbers and types of administrative personnel;</text>
    </level>
    <level label="2">
      <text>have a satisfactory grievance procedure and ability to respond to enrollees’ calls, questions, and complaints;</text>
    </level>
    <level label="3">
      <text>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</text>
    </level>
    <level label="4">
      <text>design policies to help ensure adequate access to providers of health care.</text>
    </level>
  </level>
  <level label="c">
    <text>A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.</text>
  </level>
  <level label="d">
    <text>A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.</text>
  </level>
  <level label="e">
    <text>A carrier may offer benefits in addition to those in the Standard Plan if:</text>
    <level label="1">
      <text>the additional benefits:</text>
      <level label="i">
        <text>are offered and priced separately from benefits specified in accordance with § 15–1207 of this subtitle; and</text>
      </level>
      <level label="ii">
        <text>do not have the effect of duplicating any of those benefits; and</text>
      </level>
    </level>
    <level label="2">
      <text>the carrier:</text>
      <level label="i">
        <text>clearly distinguishes the Standard Plan from other offerings of the carrier;</text>
      </level>
      <level label="ii">
        <text>indicates the Standard Plan is the only plan required by State law; and</text>
      </level>
      <level label="iii">
        <text>specifies that all enhancements to the Standard Plan are not required by State law.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>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.</text>
  </level>
  <level label="g">
    <text>A carrier may offer coverage for dental care and services as an additional benefit.</text>
  </level>
  <level label="h">
    <level label="1">
      <text>In this subsection, “prominent carrier” means a carrier that insures at least 10% of the total lives insured in the small group market.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.</text>
      </level>
      <level label="ii">
        <text>A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.</text>
      </level>
    </level>
    <level label="3">
      <text>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.</text>
    </level>
  </level>
</section>
