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<section article="gin" article_name="Insurance" number="15-1206" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <level label="1">
      <text>A carrier may not arbitrarily transfer a small employer involuntarily into or out of a health benefit plan.</text>
    </level>
    <level label="2">
      <text>A carrier may not offer to transfer a small employer into or out of a health benefit plan unless the offer to transfer is made to all small employers with similar risk adjustment factors.</text>
    </level>
  </level>
  <level label="b">
    <text>A carrier shall make a reasonable disclosure in its solicitation and sales materials of:</text>
    <level label="1">
      <text>the provisions that relate to the carrier’s right to change premium rates, including any factors that may affect the changes in premium rates;</text>
    </level>
    <level label="2">
      <text>the provisions that relate to renewability of policies and contracts;</text>
    </level>
    <level label="3">
      <text>the provisions that relate to preexisting conditions; and</text>
    </level>
    <level label="4">
      <text>the provisions of § 15–1209 of this subtitle that require an employer to make dependent coverage available to eligible employees but do not require the employer to make a contribution to the premium payments for that dependent coverage.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>Subject to the approval of the Commissioner and as provided under this subsection and § 15–1209(d) of this subtitle, a carrier may impose reasonable minimum participation requirements.</text>
    </level>
    <level label="2">
      <text>A carrier may not impose a requirement for minimum participation by the eligible employees of a small employer that is greater than 75%.</text>
    </level>
    <level label="3">
      <text>In applying a minimum participation requirement to determine whether the applicable percentage of participation is met, a carrier may not consider as eligible employees:</text>
      <level label="i">
        <text>those who have group spousal coverage under a public or private plan of health insurance or another employer’s health benefit arrangement, including Medicare, Medicaid, and CHAMPUS, that provides benefits similar to or exceeding the benefits provided under a bronze level health plan as described in 45 C.F.R. § 156.140; or</text>
      </level>
      <level label="ii">
        <text>employees who are under the age of 26 years who are covered under their parent’s health benefit plan.</text>
      </level>
    </level>
    <level label="4">
      <text>A carrier may not impose a minimum participation requirement for a small employer group if any member of the group participates in a medical savings account.</text>
    </level>
    <level label="5">
      <text>A carrier may not impose a minimum participation requirement for a qualified employer if the qualified employer designates a coverage level within which its employees may choose any qualified health plan in the SHOP Exchange, as provided for in § 31–111(c)(1) of this article.</text>
    </level>
    <level label="6">
      <text>A carrier may not impose a minimum participation requirement for a small employer group if the small employer group applies for coverage during the period that begins on November 15 and extends through December 15 of any year.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>On or before March 15 of each year, each carrier shall file an actuarial certification with the Commissioner.</text>
    </level>
    <level label="2">
      <text>The actuarial certification shall be written in a form that the Commissioner approves, by a member of the American Academy of Actuaries or another person acceptable to the Commissioner and shall state that the carrier is in compliance with this subtitle and has followed the rating practices imposed under § 15–1205 of this subtitle.</text>
    </level>
    <level label="3">
      <text>The actuarial certification shall be based on an examination that includes a review of appropriate records and actuarial assumptions and methods used by the carrier.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>To indicate compliance with subsections (b) and (c)(1) of this section and § 15–1205(e) of this subtitle, a carrier shall maintain information and documentation that is satisfactory to the Commissioner.</text>
    </level>
    <level label="2">
      <text>A carrier shall:</text>
      <level label="i">
        <text>retain all information and documentation required under this subtitle at its principal place of business for a period of 5 years; and</text>
      </level>
      <level label="ii">
        <text>make the information and documentation available to the Commissioner on request.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>A carrier may not implement a producer commission schedule that varies the amount of a commission based on the size of a small employer group unless the variation:</text>
    <level label="1">
      <text>is inversely related to the size of the small employer group;</text>
    </level>
    <level label="2">
      <text>applies to the cumulative premium paid over a specific period of time, is uniformly applied, and is inversely related to the cumulative premium paid during the period of time; or</text>
    </level>
    <level label="3">
      <text>is established by a contract between the carrier and each outside producer, and the carrier:</text>
      <level label="i">
        <text>specifies in the contract the group size to which the variation applies;</text>
      </level>
      <level label="ii">
        <text>directs the outside producer to refer small employers of the specified size to an employee of the carrier who is a licensed producer or to a company affiliated with the carrier through common ownership within an insurance holding company; and</text>
      </level>
      <level label="iii">
        <text>pays a commission to the employee producer described in item (ii) of this item.</text>
      </level>
    </level>
  </level>
  <level label="g">
    <level label="1">
      <text>A licensed insurance producer, in connection with the sale, solicitation, or negotiation of a health benefit plan to a small employer, shall:</text>
      <level label="i">
        <text>provide information to the small employer about wellness benefits; and</text>
      </level>
      <level label="ii">
        <text>advise the small employer to consult a tax advisor about the tax advantages of a payroll deduction plan under § 125 of the Internal Revenue Code.</text>
      </level>
    </level>
    <level label="2">
      <text>The information shall be provided:</text>
      <level label="i">
        <text>whenever the employer purchases or renews a health benefit plan; and</text>
      </level>
      <level label="ii">
        <text>on request.</text>
      </level>
    </level>
  </level>
  <level label="h">
    <level label="1">
      <text>In accordance with regulations adopted by the Commissioner, a licensed insurance producer may provide to a small employer information about the Maryland Medical Assistance Program and the Maryland Children’s Health Program for the small employer to distribute to its employees during the enrollment period.</text>
    </level>
    <level label="2">
      <text>The information provided under paragraph (1) of this subsection shall be restricted to general information about the Maryland Medical Assistance Program and the Maryland Children’s Health Program, including:</text>
      <level label="i">
        <text>income eligibility thresholds; and</text>
      </level>
      <level label="ii">
        <text>application instructions.</text>
      </level>
    </level>
  </level>
</section>
