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<section article="gin" article_name="Insurance" number="15-1212" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Plan” means, with respect to a product, the pairing of the health benefits under the product with a particular cost–sharing structure, provider network, and service area.</text>
    </level>
    <level label="3">
      <level label="i">
        <text>“Product” means a discrete package of health benefits that are offered using a particular product network type within a geographic service area.</text>
      </level>
      <level label="ii">
        <text>“Product” comprises all plans offered within the product.</text>
      </level>
    </level>
    <level label="4">
      <text>“Uniform modification of coverage” means a change to a small employer’s health benefit plan that meets the criteria stated in 45 C.F.R. § 147.106(e).</text>
    </level>
  </level>
  <level label="b">
    <text>Changes in benefits made in accordance with federal or State requirements are not subject to the plus or minus 2 percentage points referenced in 45 C.F.R. § 147.106(e)(3)(v).</text>
  </level>
  <level label="c">
    <text>The combination of all plans offered with a product constitutes the total service area of the product.</text>
  </level>
  <level label="d">
    <level label="1">
      <text>With respect to a plan that has been modified at the time of coverage renewal consistent with this section, the plan shall be considered to be the same plan if:</text>
      <level label="i">
        <level label="1">
          <text>the plan has the same cost–sharing structure as before the modification; or</text>
        </level>
        <level label="2">
          <text>any variation in cost sharing:</text>
        </level>
        <level label="A">
          <text>is solely related to changes in cost or utilization of medical care; or</text>
        </level>
        <level label="B">
          <text>is to maintain the same metal level described in § 1302(d) and (e) of the Affordable Care Act;</text>
        </level>
      </level>
      <level label="ii">
        <text>the plan continues to cover a majority of the same service area; and</text>
      </level>
      <level label="iii">
        <text>the plan continues to cover a majority of the same provider network.</text>
      </level>
    </level>
    <level label="2">
      <text>Notwithstanding paragraph (1) of this subsection, the plan shall be considered to be the same plan to the extent that the modifications are:</text>
      <level label="i">
        <text>made uniformly and solely as a result of a federal or State requirement;</text>
      </level>
      <level label="ii">
        <text>made within a reasonable time period after the imposition or modification of the federal or State requirement; and</text>
      </level>
      <level label="iii">
        <text>directly related to the imposition or modification of the federal or State requirement.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>Except as provided in subsections (f), (g), and (h) of this section, a carrier shall renew a health benefit plan at the option of the small employer.</text>
    </level>
    <level label="2">
      <text>On renewal, a carrier may not exclude eligible employees or dependents from a health benefit plan.</text>
    </level>
    <level label="3">
      <level label="i">
        <text>A carrier shall mail a notice of renewal to the small employer at least 60 days before the expiration of a health benefit plan.</text>
      </level>
      <level label="ii">
        <text>The notice of renewal shall include the dates of the renewal period, the health benefit plan rates, and the terms of coverage under the health benefit plan.</text>
      </level>
    </level>
    <level label="4">
      <text>Policies or certificates for hospital or medical benefits issued through a professional employer organization, coemployer, or other organization under this subtitle may, with the consent of the carrier, have a common renewal date.</text>
    </level>
  </level>
  <level label="f">
    <text>A carrier may cancel or refuse to renew a health benefit plan only:</text>
    <level label="1">
      <text>for nonpayment of premiums;</text>
    </level>
    <level label="2">
      <text>for fraud or intentional misrepresentation of material fact by the small employer;</text>
    </level>
    <level label="3">
      <text>for noncompliance with a material plan provision relating to employer contributions or group participation rules;</text>
    </level>
    <level label="4">
      <text>when the carrier elects not to renew:</text>
      <level label="i">
        <text>all of its health benefit plans that are issued to small employers in the State; or</text>
      </level>
      <level label="ii">
        <text>the particular product for all small employers in the State; or</text>
      </level>
    </level>
    <level label="5">
      <text>in the case of a health maintenance organization, where there is no longer any enrollee who lives, resides, or works in the health maintenance organization’s approved service area, provided notice of the termination is provided to each small employer and to each employee covered under the health benefit plan at least 90 calendar days before the date coverage will be terminated.</text>
    </level>
  </level>
  <level label="g">
    <text>When a carrier elects not to renew all health benefit plans in the State, the carrier:</text>
    <level label="1">
      <text>shall give notice of its decision to the affected small employers and the insurance regulatory authority of each state in which an eligible employee or dependent resides at least 180 days before the effective date of nonrenewal;</text>
    </level>
    <level label="2">
      <text>shall give notice to the Commissioner at least 30 working days before giving the notice specified in item (1) of this subsection; and</text>
    </level>
    <level label="3">
      <text>may not write new business for small employers in the State for a period of 5 years beginning on the date of notice to the Commissioner.</text>
    </level>
  </level>
  <level label="h">
    <text>When a carrier elects not to renew a particular product for all small employers in the State, the carrier shall:</text>
    <level label="1">
      <text>provide notice of the nonrenewal at least 90 days before the date of the nonrenewal to:</text>
      <level label="i">
        <text>each affected:</text>
        <level label="1">
          <text>small employer; and</text>
        </level>
        <level label="2">
          <text>enrolled employee; and</text>
        </level>
      </level>
      <level label="ii">
        <text>the Commissioner;</text>
      </level>
    </level>
    <level label="2">
      <text>offer to each affected small employer the option to purchase all other health benefit plans currently offered by the carrier in the small group market; and</text>
    </level>
    <level label="3">
      <text>act uniformly without regard to the claims experience of any affected small employer, or any health status–related factor of any affected individual.</text>
    </level>
  </level>
  <level label="i">
    <level label="1">
      <text>Within 7 days after cancellation or nonrenewal of a health benefit plan, the carrier shall send to each enrolled employee:</text>
      <level label="i">
        <text>written notice of its action; and</text>
      </level>
      <level label="ii">
        <text>notice delivered by electronic means that complies with § 27–601.2 of this article.</text>
      </level>
    </level>
    <level label="2">
      <text>The notice required under paragraph (1) of this subsection shall include information on additional health benefit coverage options, including continuation of coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), if available, and plans available through the Maryland Health Benefit Exchange.</text>
    </level>
  </level>
  <level label="j">
    <text>A carrier may make a uniform modification of coverage for a product only at the time of renewal of the health benefit plan.</text>
  </level>
  <level label="k">
    <text>A carrier will not be considered to have elected not to renew all health benefit plans that are issued to small employers in the State if the carrier complies with 45 C.F.R. § 147.106(d)(3).</text>
  </level>
</section>
