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<section article="gin" article_name="Insurance" number="15-1A-09" title_number="15" title_name="Health Insurance" subtitle_number="1A" subtitle_name="Consumer Protections">
  <level label="a">
    <text>Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article:</text>
    <level label="1">
      <text>Subtitle 4 of this title;</text>
    </level>
    <level label="2">
      <text>§§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title;</text>
    </level>
    <level label="3">
      <text>§§ 15–1316 and 15–1318 of this title; and</text>
    </level>
    <level label="4">
      <text>§§ 15–1406 and 15–1406.1 of this title.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>Except as provided in paragraph (2) of this subsection, a carrier may restrict enrollment to open or special enrollment periods.</text>
    </level>
    <level label="2">
      <text>A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year.</text>
    </level>
  </level>
  <level label="c">
    <text>If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier:</text>
    <level label="1">
      <level label="i">
        <text>may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and</text>
      </level>
      <level label="ii">
        <text>if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or</text>
      </level>
    </level>
    <level label="2">
      <text>may deny coverage within a service area if the carrier:</text>
      <level label="i">
        <text>demonstrates to the Commissioner that:</text>
        <level label="1">
          <text>the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and</text>
        </level>
        <level label="2">
          <text>the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and</text>
        </level>
      </level>
      <level label="ii">
        <text>does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>A carrier may deny coverage if the carrier:</text>
    <level label="1">
      <text>demonstrates to the Commissioner that:</text>
      <level label="i">
        <text>the carrier does not have the financial reserves necessary to underwrite additional coverage; and</text>
      </level>
      <level label="ii">
        <text>the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and</text>
      </level>
    </level>
    <level label="2">
      <text>unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.</text>
    </level>
  </level>
</section>
