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<section article="gin" article_name="Insurance" number="15-1207" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <text>In accordance with Title 19, Subtitle 1 of the Health – General Article, the Commission shall adopt regulations that specify:</text>
    <level label="1">
      <text>the Comprehensive Standard Health Benefit Plan to apply under this subtitle; and</text>
    </level>
    <level label="2">
      <text>the requirements for a wellness benefit offered by a carrier to apply under this subtitle.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>Subject to paragraph (2) of this subsection, the Commission shall exclude or limit benefits or adjust cost–sharing arrangements in the Standard Plan if the average rate for the Standard Plan exceeds 10% of the average annual wage in the State.</text>
    </level>
    <level label="2">
      <text>The Commission annually shall determine the average rate for the Standard Plan by using the average rate submitted by each carrier that offers the Standard Plan.</text>
    </level>
  </level>
  <level label="c">
    <text>In establishing benefits, the Commission shall judge preventive services, medical treatments, procedures, and related health services based on:</text>
    <level label="1">
      <text>their effectiveness in improving the health status of individuals;</text>
    </level>
    <level label="2">
      <text>their impact on maintaining and improving health and on reducing the unnecessary consumption of health care services; and</text>
    </level>
    <level label="3">
      <text>their impact on the affordability of health care coverage.</text>
    </level>
  </level>
  <level label="d">
    <text>The Commission may exclude:</text>
    <level label="1">
      <text>a health care service, benefit, coverage, or reimbursement for covered health care services that is required under this article or the Health – General Article to be provided or offered in a health benefit plan that is issued or delivered in the State by a carrier; or</text>
    </level>
    <level label="2">
      <text>reimbursement required by statute, by a health benefit plan for a service when that service is performed by a health care provider who is licensed under the Health Occupations Article and whose scope of practice includes that service.</text>
    </level>
  </level>
  <level label="e">
    <text>The Commission shall include mental health and substance abuse benefits required under § 15–802 of this title and § 19–703.1 of the Health – General Article for employers that meet the large employer definition under § 15–802 of this title and § 19–703.1 of the Health – General Article.</text>
  </level>
  <level label="f">
    <text>The Commission shall specify the deductibles and cost–sharing associated with the benefits in the Standard Plan.</text>
  </level>
  <level label="g">
    <text>In establishing cost–sharing as part of the Standard Plan, the Commission shall:</text>
    <level label="1">
      <text>include cost–sharing and other incentives to help prevent consumers from seeking unnecessary services;</text>
    </level>
    <level label="2">
      <text>balance the effect of cost–sharing in reducing premiums and in affecting utilization of appropriate services; and</text>
    </level>
    <level label="3">
      <text>limit the total cost–sharing that may be incurred by an individual in a year.</text>
    </level>
  </level>
  <level label="h">
    <text>Beginning January 1, 2014, this section applies only to grandfathered health plans as defined in § 1251 of the Affordable Care Act.</text>
  </level>
</section>
