In this subtitle the following words have the meanings indicated. “Association” or “bona fide association” means, with respect to health insurance coverage offered in this State, an association that: has been actively in existence for at least 5 years; has been formed and maintained in good faith for purposes other than obtaining insurance and does not condition membership on the purchase of association–sponsored insurance; does not condition membership in the association on any health status–related factor relating to an individual, and states so clearly in all membership and application materials; makes health insurance coverage offered through the association available to all members regardless of any health status–related factor relating to the members or individuals eligible for coverage through a member and states so clearly in all membership and application materials; does not make health insurance coverage offered through the association available other than in connection with membership in the association and states so clearly in all marketing and application materials; and provides and annually updates information necessary for the Commissioner to determine whether or not the association meets the definition of bona fide association before qualifying as an association under this subtitle. “Carrier” means a person that is: an insurer that holds a certificate of authority in the State and provides health insurance in the State; a health maintenance organization that is licensed to operate in the State; a nonprofit health service plan that is licensed to operate in the State; or any other person or organization that provides health benefit plans subject to State insurance regulation. “Church plan” means a plan as defined under § 3(33) of the Employee Retirement Income Security Act of 1974. “Employer sponsored plan” means an employee welfare benefit plan that provides medical care to employees or their dependents, and is not subject to State regulation in accordance with the federal Employee Retirement Income Security Act of 1974. “Enrollment date” means the date on which: an individual enrolls in a health benefit plan; or the first day of the waiting period before which the individual may enroll. “Governmental plan” means a plan as defined in § 3(32) of the Employee Retirement Income Security Act of 1974 and any federal governmental plan. “Health benefit plan” means any: hospital or medical policy, including those issued under multiple employer trusts or associations located in Maryland or any other state covering Maryland residents; policy or contract issued by a nonprofit health service plan that covers Maryland residents; or health maintenance organization subscriber or group master contract. “Health benefit plan” does not include: one or more, or any combination of the following: coverage only for accident or disability income insurance; coverage issued as a supplement to liability insurance; liability insurance, including general liability insurance and automobile liability insurance; workers’ compensation or similar insurance; automobile medical payment insurance; credit–only insurance; coverage for on–site medical clinics; and other similar insurance coverage, specified in federal regulations issued under the federal Health Insurance Portability and Accountability Act, under which benefits for medical care are secondary or incidental to other insurance benefits; the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan: limited scope dental or vision benefits; benefits for long–term care, nursing home care, home health care, community–based care, or any combination of these benefits; and such other similar, limited benefits as are specified in federal regulations issued under the federal Health Insurance Portability and Accountability Act; the following benefits if offered as independent, noncoordinated benefits: coverage only for a specified disease or illness; and hospital indemnity or other fixed indemnity insurance, if the benefits are payable in a fixed dollar amount per period of time, regardless of the amount of expenses incurred; or the following benefits if offered as a separate insurance policy: Medicare supplemental health insurance (as defined under § 1882(g)(1) of the Social Security Act); coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and similar supplemental coverage provided to coverage under an employer sponsored plan if the coverage qualifies for the exception described in 45 C.F.R. § 146.145(b)(5)(i)(C). “Health status–related factor” means a factor related to: health status; medical condition; claims experience; receipt of health care; medical history; genetic information; evidence of insurability including conditions arising out of acts of domestic violence; or disability. “Late enrollee” means a member, subscriber, or dependent who enrolls in a group health benefit plan other than during: the first period in which the individual is eligible to enroll under the plan; or a special enrollment period. “Preexisting condition” means a condition that was present before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. “Preexisting condition provision” means a provision in a health benefit plan that denies, excludes, or limits benefits for an enrollee for expenses or services related to a preexisting condition. “Secretary” means the Secretary of the federal Department of Health and Human Services. “Special enrollment period” means a period during which a group health plan shall permit certain individuals who are eligible for coverage, but not enrolled, to enroll for coverage under the terms of the group health benefit plan. “Waiting period” means the period of time that must pass before an individual is eligible to be covered for benefits under the terms of a group health benefit plan.

Subject to subsection (b) of this section, this subtitle applies to all carriers in connection with group health benefit plans. This subtitle does not apply to policies issued under Subtitle 12 of this title.

A carrier may not establish rules for eligibility of an individual to enroll under a group health benefit plan based on any health status-related factor. Subsection (a) of this section does not: require a carrier to provide particular benefits other than those provided under the terms of the particular health benefit plan; or prevent a carrier from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the health benefit plan. Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment. A carrier shall allow an employee or dependent who is eligible, but not enrolled, for coverage under the terms of a group health benefit plan to enroll for coverage under the terms of the plan if: the employee or dependent was covered under an employer-sponsored plan or group health benefit plan at the time coverage was previously offered to the employee or dependent; the employee states in writing, at the time coverage was previously offered, that coverage under an employer-sponsored plan or group health benefit plan was the reason for declining enrollment, but only if the plan sponsor or issuer requires the statement and provides the employee with notice of the requirement; the employee’s or dependent’s coverage described in item (1) of this subsection: was under a COBRA continuation provision, and the coverage under that provision was exhausted; or was not under a COBRA continuation provision, and either the coverage was terminated as a result of loss of eligibility for the coverage, including loss of eligibility as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or employer contributions towards the coverage were terminated; and under the terms of the plan, the employee requests enrollment not later than 30 days after: the date of exhaustion of coverage described in item (3)(i) of this subsection; or termination of coverage or termination of employer contributions described in item (3)(ii) of this subsection.

In this section, “eligible employee” means: a participant under the group health benefit plan; or an individual who: has met any waiting period applicable to becoming a participant under the group health benefit plan; is eligible to be enrolled under the plan; and is not a participant in the group health benefit plan because of failure to enroll during a previous enrollment period. This section applies if a group health benefit plan makes coverage available to dependents of an eligible employee. A group health benefit plan subject to this section shall provide a special enrollment period during which the following individuals may be enrolled under the group health benefit plan: an individual who becomes a dependent of an eligible employee through marriage, birth, adoption, or placement for adoption; an eligible employee who acquires a new dependent through marriage, birth, adoption, or placement for adoption; and the spouse of an eligible employee at the birth or adoption of a child, provided the spouse is otherwise eligible for coverage. An eligible employee may not enroll a dependent during a special enrollment period unless the eligible employee: is enrolled under the health benefit plan; or applies for coverage for the eligible employee during the same special enrollment period. The special enrollment period under subsection (c) of this section shall be a period of not less than 31 days and shall begin on the later of: the date dependent coverage is made available; or the date of the marriage, birth, adoption, or placement for adoption, whichever is applicable. If an eligible employee enrolls any of the individuals described in subsection (c) of this section during the first 31 days of the special enrollment period, the coverage shall become effective as follows: in the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received; in the case of a dependent’s birth, as of the date of the dependent’s birth; and in the case of a dependent’s adoption or placement for adoption, the date of adoption or placement for adoption, whichever occurs first.

A carrier may not require an individual member of a group to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual, based on any health status-related factor.

A carrier shall renew group health benefit plans at the option of the policyholder or plan sponsor, except in any of the following cases: for nonpayment of the required premium; where the policyholder or plan sponsor has performed an act or practice that constitutes fraud; where the policyholder or plan sponsor has made an intentional misrepresentation of material fact under the terms of the coverage; where the policyholder or plan sponsor has failed to comply with a material plan provision relating to the employer contributions or group participation rules; where the carrier elects not to renew all group health benefit plans in the State; 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 nonrenewal is provided to each employer and to each employee covered under the health benefit plan at least 90 days before the date coverage will be terminated; in the case of a carrier that offers coverage only through one or more bona fide associations, when the membership of an employer in the association ceases and nonrenewal under this item is applied uniformly without regard to any health status–related factor relating to any covered individual; or the carrier makes an election under § 15–1409 of this subtitle.

In this section, “product” means a discrete package of health benefits that are offered using a particular product network type within a geographic service area. A carrier that elects not to renew all of a particular product in the State shall: provide notice of the nonrenewal at least 90 days before the date of the nonrenewal to each affected: policyholder; plan sponsor; participant; and beneficiary; offer to each affected plan sponsor the option to purchase any other health insurance coverage currently being offered by the carrier; and act uniformly without regard to the claims experience of any affected plan sponsor, or any health status–related factor of any affected individual. A carrier may elect not to renew all group health benefit plans in the State. When a carrier elects not to renew all group health benefit plans in the State, the carrier: shall give notice of its decision to the affected individuals at least 180 days before the effective date of nonrenewal; at least 30 working days before that notice, shall give notice to the Commissioner; and may not write new business for groups in the State for a 5–year period beginning on the date of notice to the Commissioner. A health maintenance organization need not offer coverage to an individual who does not live, reside, or work within the health maintenance organization’s approved service areas. A carrier may make a uniform modification of coverage for a product only at the time of renewal of a health benefit plan. A carrier will not be considered to have elected not to renew all group health benefit plans in the State if the carrier complies with 45 C.F.R. § 147.106(d)(3).

In this section, “plan year” has the meaning stated in § 15–1201 of this title. The guaranteed issuance of coverage provision in Title I, Subtitle C of the Affordable Care Act applies to each health benefit plan with a plan year that begins on or after January 1, 2014.

In this section the following words have the meanings indicated. “Aggregate incurred claims” means the total claims incurred in the experience period that the carrier uses to experience rate a large employer’s health benefit plan. “Experience rating” means that a carrier develops the premium rates for an employer’s health benefit plan based in whole or in part on the claims experience of the group that consists of the employer’s employees or employees’ dependents. “Large employer” means an employer that is not a small employer as defined in § 31–101 of this article. If a carrier is experience rating a large employer’s health benefit plan, the carrier shall disclose the aggregate incurred claims of the group to the large employer within 30 days after receipt of a request from the large employer. The aggregate incurred claims required to be disclosed under subsection (b) of this section shall be provided in a format that complies with the privacy requirements of the federal Health Insurance Portability and Accessibility Act.