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<section article="gin" article_name="Insurance" number="15-1A-07" title_number="15" title_name="Health Insurance" subtitle_number="1A" subtitle_name="Consumer Protections">
  <level label="a">
    <level label="1">
      <text>This section may not be construed to limit the authority of the Commissioner to conduct a health benefit plan premium rate review under Title 11, Subtitle 6 of this article.</text>
    </level>
    <level label="2">
      <text>This section applies only to a carrier offering an individual plan and, subject to § 15–1205 of this title, a carrier offering a small group plan.</text>
    </level>
  </level>
  <level label="b">
    <text>A carrier may determine a premium rate based on:</text>
    <level label="1">
      <text>subject to subsection (c) of this section, age;</text>
    </level>
    <level label="2">
      <text>geography based on the following contiguous areas of the State:</text>
      <level label="i">
        <text>the Baltimore metropolitan area;</text>
      </level>
      <level label="ii">
        <text>the District of Columbia metropolitan area;</text>
      </level>
      <level label="iii">
        <text>Western Maryland; and</text>
      </level>
      <level label="iv">
        <text>Eastern Maryland and Southern Maryland;</text>
      </level>
    </level>
    <level label="3">
      <text>subject to subsection (d) of this section, whether the plan covers an individual or a family; and</text>
    </level>
    <level label="4">
      <text>subject to subsection (e) of this section, tobacco use.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>In this subsection, “age” means an individual’s age as of the date of issuance or renewal of a health benefit plan.</text>
    </level>
    <level label="2">
      <text>For individuals who are 21 years of age or older, a premium rate based on age:</text>
      <level label="i">
        <text>may not vary by more than a ratio of 3 to 1 for adults;</text>
      </level>
      <level label="ii">
        <text>shall provide for 1–year age bands for individuals at least 21 years old and under the age of 64 years; and</text>
      </level>
      <level label="iii">
        <text>shall provide for a single age band for individuals at least 64 years old.</text>
      </level>
    </level>
    <level label="3">
      <text>For individuals who are under the age of 21 years, a premium rate based on age shall:</text>
      <level label="i">
        <text>be actuarially justified and consistent with the uniform age rating curve established in accordance with paragraph (4) of this subsection;</text>
      </level>
      <level label="ii">
        <text>provide for a single age band for individuals under the age of 15 years; and</text>
      </level>
      <level label="iii">
        <text>provide for 1–year age bands for individuals at least 15 years old and under the age of 20 years.</text>
      </level>
    </level>
    <level label="4">
      <text>The uniform age rating curve required under paragraph (3)(i) of this subsection may be established by the Commissioner in the individual market, small group market, or both markets.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>A rating variation for a health benefit plan that provides coverage for a family shall be applied based on the portion of the premium attributable to each family member covered.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>Subject to subparagraph (ii) of this paragraph, a premium for a health benefit plan that provides coverage for a family shall be determined by summing the premiums for each individual family member.</text>
      </level>
      <level label="ii">
        <text>For a health benefit plan that provides family coverage for individuals under the age of 21 years, the sum shall include not more than the premiums for the three oldest individuals under the age of 21 years.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <text>A premium rate based on tobacco use may not vary by more than a ratio of 1.5 to 1.</text>
  </level>
</section>
