Insurance (GIN) — Title 31. Maryland Health Benefit Exchange
Statutes in effect as of October 1, 2026.
Subtitle 1. Maryland Health Benefit Exchange
Md. Code Ann., Ins. § 31-101 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–101LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(a–1)
“Application counselor” means an individual who holds an Individual Exchange application counselor certification issued under § 31–113(r) of this subtitle.
(a–2)
“Application counselor sponsoring entity” or “sponsoring entity” means an entity designated by the Individual Exchange as a sponsoring entity under § 31–113(r) of this subtitle.
(b)
“Board” means the Board of Trustees of the Exchange.
(b–1)
“Captive producer” means an insurance producer who:
(1)
is licensed in the State and authorized by the Commissioner to sell, solicit, or negotiate health insurance;
(2)
receives an authorization and meets the other requirements set forth in § 31–113(n)(2) of this subtitle;
(3)
has a current and exclusive appointment with a single carrier; and
(4)
receives compensation as a captive producer only from that carrier.
(c)
“Carrier” means:
(1)
an insurer authorized to sell health insurance;
(2)
a nonprofit health service plan;
(3)
a health maintenance organization;
(4)
a dental plan organization; or
(5)
any other entity providing a plan of health insurance, health benefits, or health services authorized under this article or the Affordable Care Act.
(c–1)
“Consolidated Services Center” or “CSC” means the consumer assistance call center established in accordance with the requirement to operate a toll–free hotline under § 1311(d)(4) of the Affordable Care Act and § 31–108(b)(5) of this subtitle.
(d)
“Coverage level” means a level of coverage, as defined in § 1302 of the Affordable Care Act and as determined in regulations adopted by the Secretary, for a qualified health plan.
(e)
(1)
“Exchange” means the Maryland Health Benefit Exchange established as a public corporation under § 31–102 of this subtitle.
(2)
“Exchange” includes:
(i)
the Individual Exchange; and
(ii)
the Small Business Health Options Program (SHOP Exchange).
(e–1)
(1)
‘‘Full–time employee’’ means, with respect to a calendar month, an employee of a small employer who works, on average, at least 30 hours per week.
(2)
‘‘Full–time employee’’ does not include a seasonal employee as defined in federal law.
(f)
“Fund” means the Maryland Health Benefit Exchange Fund established under § 31–107 of this subtitle.
(g)
(1)
“Health benefit plan” means a policy, contract, certificate, or agreement offered, issued, or delivered by a carrier to an individual or small employer in the State to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
(2)
“Health benefit plan” does not include:
(i)
coverage only for accident or disability insurance or any combination of accident and disability insurance;
(ii)
coverage issued as a supplement to liability insurance;
(iii)
liability insurance, including general liability insurance and automobile liability insurance;
(iv)
workers’ compensation or similar insurance;
(v)
automobile medical payment insurance;
(vi)
credit–only insurance;
(vii)
coverage for on–site medical clinics; or
(viii)
other similar insurance coverage, specified in federal regulations issued pursuant to the federal Health Insurance Portability and Accountability Act, under which benefits for health care services are secondary or incidental to other insurance benefits.
(3)
“Health benefit plan” does not include 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:
(i)
limited scope dental or vision benefits;
(ii)
benefits for long–term care, nursing home care, home health care, community–based care, or any combination of these benefits; or
(iii)
such other similar limited benefits as are specified in federal regulations issued pursuant to the federal Health Insurance Portability and Accountability Act.
(4)
“Health benefit plan” does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether the benefits are provided under any group health plan maintained by the same plan sponsor:
(i)
coverage only for a specified disease or illness;
(ii)
group hospital indemnity or other fixed indemnity insurance, if the benefits are payable in a fixed dollar amount per period of time, such as $100 per day of hospitalization, regardless of the amount of expenses incurred; or
(iii)
individual hospital indemnity or other fixed indemnity insurance, if:
(1)
the benefits are paid in a fixed dollar amount per period of hospitalization, illness, or service, regardless of the amount of expenses incurred and of the amount of benefits provided with respect to the event or service under any other health coverage; and
(2)
a notice is displayed prominently in the application materials, in at least 14 point type, that has the following language in capital letters: “This is a supplement to health insurance and is not a substitute for major medical coverage. Lack of major medical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.”.
(5)
“Health benefit plan” does not include the following if offered as a separate policy, certificate, or contract of insurance:
(i)
Medicare supplemental insurance (as defined under § 1882(g)(1) of the Social Security Act);
(ii)
coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)); or
(iii)
similar supplemental coverage provided to coverage under a group health plan if the coverage qualifies for the exception described in 45 C.F.R. § 146.145(b)(5)(i)(C).
(h)
“Health literacy” means the degree to which an individual has the capacity to obtain, process, and understand health information and services in order to make an appropriate health decision.
(i)
“Individual Exchange” means the division of the Exchange that serves the individual health insurance market.
(j)
“Individual Exchange connector entity” means a community–based organization or other entity or a partnership of entities that:
(1)
is authorized by the Individual Exchange under § 31–113(f) of this subtitle; and
(2)
employs or engages Individual Exchange navigators to provide the services described in § 31–113(d)(1) of this subtitle.
(k)
“Individual Exchange connector entity authorization” means a grant of authority from the Individual Exchange to an Individual Exchange connector entity under § 31–113(f) of this subtitle.
(l)
“Individual Exchange navigator” means an individual who:
(1)
holds an Individual Exchange navigator certification; and
(2)
provides the services described in § 31–113(d)(1) of this subtitle for an Individual Exchange connector entity.
(m)
“Individual Exchange navigator certification” means a certificate issued by the Individual Exchange that authorizes an individual to act as an Individual Exchange navigator.
(n)
“Insurance producer authorization” means a permit issued by the SHOP Exchange or Individual Exchange to allow an insurance producer to sell qualified plans in the SHOP Exchange or Individual Exchange.
(o)
“Managed care organization” has the meaning stated in § 15–101 of the Health – General Article.
(p)
“Maryland Health Care Reform Coordinating Council” means the joint executive–legislative council established and expanded by Executive Orders 01.01.2010.07 and 01.01.2011.10.
(p–1)
(1)
“Minimum essential coverage” means:
(i)
Medicare;
(ii)
the Maryland Medical Assistance Program;
(iii)
the Maryland Children’s Health Insurance Program;
(iv)
medical coverage under 10 U.S.C. §§ 1071 through 1110b;
(v)
a health care program under 38 U.S.C. §§ 1701 through 1788 or 38 U.S.C. §§ 1802 through 1834, as determined by the Secretary of Veterans Affairs in coordination with the Secretary of Health and Human Services and the Secretary of the Treasury;
(vi)
a health plan under 22 U.S.C. § 2504(e);
(vii)
the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under 10 U.S.C. § 1587;
(viii)
coverage under an eligible employer–sponsored plan, as defined in 26 U.S.C. § 5000A;
(ix)
coverage under a health plan offered in the individual market in the State;
(x)
coverage under a grandfathered health plan; or
(xi)
other coverage as the Exchange recognizes, consistent with policy goals of Subtitle 2 of this title.
(2)
“Minimum essential coverage” does not include:
(i)
health insurance coverage that consists of coverage of excepted benefits described in:
(1)
§ 2791(c)(1) of the Public Health Service Act; or
(2)
§ 2791(c)(2), (3), or (4) of the Public Health Service Act if the benefits are provided under a separate policy, certificate, or contract of insurance;
(ii)
a short–term limited duration insurance;
(iii)
an association health plan that fails to meet the requirements of the State small group market or, in the case of a plan purchased by sole proprietors, the State individual market; or
(iv)
another form of coverage identified by the Exchange that:
(1)
does not meet the requirements of Title I of the Affordable Care Act; and
(2)
undermines the stability or increases average premiums in the individual or small group market.
(p–2)
“Plan year” has the meaning stated in § 15–1201 of this article.
(q)
“Qualified dental plan” means a dental plan certified by the Exchange that provides limited scope dental benefits, as described in § 31–108(b)(2) of this subtitle.
(r)
“Qualified employer” means a small employer that elects to make its full–time employees and, at the option of the employer, some or all of its part–time employees eligible for one or more qualified health plans offered through the SHOP Exchange, provided that the employer:
(1)
has its principal place of business in the State and elects to provide coverage through the SHOP Exchange to all of its eligible employees, wherever employed; or
(2)
elects to provide coverage through the SHOP Exchange to all of its eligible employees who are principally employed in the State.
(s)
“Qualified health plan” means a health benefit plan that has been certified by the Exchange to meet the criteria for certification described in § 1311(c) of the Affordable Care Act and § 31–115 of this subtitle.
(t)
“Qualified individual” means an individual, including a minor, who at the time of enrollment:
(1)
is seeking to enroll in a qualified health plan offered to individuals through the Exchange;
(2)
resides in the State;
(3)
is not incarcerated, other than incarceration pending disposition of charges; and
(4)
is, and reasonably is expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States.
(u)
“Qualified plan” means a:
(1)
qualified health plan;
(2)
qualified dental plan; and
(3)
qualified vision plan.
(u–1)
“Qualified resident” means an individual, including a minor, regardless of immigration status, who at the time of enrollment:
(1)
is seeking to enroll in a qualified plan offered to individuals through the Exchange;
(2)
resides in the State;
(3)
is not incarcerated, other than incarceration pending disposition of charges; and
(4)
is not eligible for the federal premium tax credit, the Maryland Medical Assistance Program, Medicare, the Maryland Children’s Health Plan, or employer–sponsored minimum essential coverage.
(v)
“Qualified vision plan” means a vision plan certified by the Exchange that provides limited scope vision benefits, as described in § 31–108(b)(3) of this subtitle.
(w)
“Secretary” means the Secretary of the federal Department of Health and Human Services.
(x)
“SHOP Exchange” means the Small Business Health Options Program authorized under § 31–108(b)(13) of this subtitle.
(y)
“SHOP Exchange navigator” means an individual engaged by the SHOP Exchange and authorized by the Commissioner to provide the services described in § 31–112(c)(1) of this subtitle.
(z)
“SHOP Exchange navigator license” means a license issued by the Commissioner that authorizes an individual to carry out the functions set forth in § 31–112(c) of this subtitle in the SHOP Exchange.
(aa)
(1)
“Small employer” means an employer that, during the preceding calendar year, employed an average of not more than 50 employees.
(2)
For purposes of this subsection:
(i)
all persons treated as a single employer under § 414(b), (c), or (o) of the Internal Revenue Code shall be treated as a single employer;
(ii)
an employer and any predecessor employer shall be treated as a single employer;
(iii)
the number of employees of an employer shall be determined by adding:
(1)
the number of full–time employees; and
(2)
the number of full–time equivalent employees, which shall be calculated for a particular month by dividing the aggregate number of hours of service of employees who are not full–time employees for the month by 120;
(iv)
if an employer was not in existence throughout the preceding calendar year, the determination of whether the employer is a small employer shall be based on the average number of employees that the employer is reasonably expected to employ on business days in the current calendar year;
(v)
an employer that makes enrollment in qualified health plans available to its employees through the SHOP Exchange, and would cease to be a small employer by reason of an increase in the number of its employees, shall continue to be treated as a small employer for purposes of this subtitle as long as it continuously makes enrollment through the SHOP Exchange available to its employees; and
(vi)
to the extent permitted by federal law, an entity that leases employees from a professional employer organization, coemployer, or other organization engaged in employee leasing and that otherwise meets the description in this section shall be treated as a small employer.
(bb)
“State benchmark plan” means the health benefit plan designated by the State, under regulations adopted by the Secretary, to serve as the standard for the essential health benefits to be offered by:
(1)
qualified health plans inside the Exchange;
(2)
individual health benefit plans, except grandfathered health plans, as defined in § 1251 of the Affordable Care Act; and
(3)
health benefit plans offered to small employers, except grandfathered health plans, as defined in § 1251 of the Affordable Care Act.
Md. Code Ann., Ins. § 31-102 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–102LinkCopy Citation
(a)
There is a Maryland Health Benefit Exchange.
(b)
(1)
The Exchange is a body politic and corporate and is an instrumentality of the State.
(2)
The Exchange is a public corporation and a unit of State government.
(3)
The exercise by the Exchange of its authority under this subtitle is an essential governmental function.
(c)
The purposes of the Exchange are to:
(1)
reduce the number of uninsured in the State;
(2)
facilitate the purchase and sale of qualified health plans in the individual market in the State by providing a transparent marketplace;
(3)
assist qualified employers in the State in facilitating the enrollment of their employees in qualified health plans in the small group market in the State and in accessing small business tax credits;
(4)
assist individuals in accessing public programs, premium tax credits, and cost–sharing reductions; and
(5)
supplement the individual and small group insurance markets outside of the Exchange.
(d)
Nothing in this subtitle, and no regulation adopted or other action taken by the Exchange under this subtitle, may be construed to:
(1)
preempt or supersede:
(i)
the authority of the Commissioner to regulate insurance business in the State; or
(ii)
the requirements of the Affordable Care Act;
(2)
authorize the Exchange to carry out any function not authorized by the Affordable Care Act; or
(3)
authorize the Exchange to offer any products or services except qualified health plans, qualified dental plans, and qualified vision plans.
Md. Code Ann., Ins. § 31-103 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–103LinkCopy Citation
(a)
The Exchange is subject to:
(1)
the following provisions of the General Provisions Article:
(i)
Title 3 (Open Meetings Act);
(ii)
Title 4 (Public Information Act); and
(iii)
Title 5 (Maryland Public Ethics Law);
(2)
the following provisions of the State Finance and Procurement Article:
(i)
Title 3.5, Subtitle 3 (Information Processing), to the extent that the Secretary of Information Technology determines that an information technology project of the Exchange is a major information technology development project;
(ii)
Title 12, Subtitle 4 (Policies and Procedures for Exempt Units); and
(iii)
Title 14, Subtitle 3 (Minority Business Participation);
(3)
the following provisions of the State Government Article:
(i)
Title 10, Subtitle 1 (Administrative Procedure Act – Regulations); and
(ii)
Title 12 (Immunity and Liability); and
(4)
Title 5, Subtitle 3 of the State Personnel and Pensions Article.
(b)
The Exchange is not subject to:
(1)
taxation by the State or local government;
(2)
Title 3.5, Subtitle 3 (Information Processing) of the State Finance and Procurement Article, except to the extent determined by the Secretary of Information Technology under subsection (a)(2)(i) of this section;
(3)
Division II of the State Finance and Procurement Article, except as provided in subsection (a)(2)(ii) and (iii) of this section;
(4)
Title 10 of the State Government Article, except as provided in subsection (a)(3)(i) of this section;
(5)
Division I of the State Personnel and Pensions Article, except as provided in subsection (a)(4) of this section and elsewhere in this title; or
(6)
this article, except as provided in subsection (c) of this section and elsewhere in this subtitle.
(c)
(1)
Except as provided in paragraph (3) of this subsection, to the extent that the Exchange, acting on behalf of a carrier offering a qualified plan in the Individual Exchange or the SHOP Exchange, is required by law or contract to collect premiums, conduct billing, send required notices, provide required disclosures, or take any other action normally taken by a carrier under this article, the carrier is not liable or subject to regulatory sanction by the Commissioner for the failure of the Exchange to comply with the law or contract in taking an action under this subsection.
(2)
(i)
Subject to subparagraph (ii) of this paragraph, the Commissioner shall regulate the Exchange in taking an action under this subsection.
(ii)
If the Commissioner finds that the Exchange has failed to comply with the law or contract in taking an action under this subsection, the Commissioner:
(1)
may not impose a fine or an administrative penalty on the Exchange; and
(2)
may require the Exchange to:
(A)
make restitution, not to exceed the amount of actual economic damages sustained by the consumer, to a consumer who has sustained actual economic damages because of the failure of the Exchange to comply with the law or contract in taking an action; and
(B)
make restitution, not to exceed the amount of actual premium, premium subsidies, or cost–sharing subsidies the carrier did not receive, to a carrier that has authorized, provided, or paid for health care services without receiving premium, premium subsidies, or cost–sharing subsidies the carrier otherwise would have received but for the failure of the Exchange to comply with the law or contract in taking an action.
(3)
(i)
The Exchange and the carrier shall hold a consumer harmless from any adverse consequence that is:
(1)
related to the consumer’s purchase of, or coverage under, a qualified plan; and
(2)
caused by the failure of the Exchange to comply with the law or contract in taking an action under this subsection.
(ii)
Holding the consumer harmless shall include:
(1)
the extension of deadlines or other accommodations necessary to protect the consumer; and
(2)
the carrier’s authorization of, provision of, or payment for health care services the carrier otherwise would be under an obligation to authorize, provide, or pay for except for the failure of the Exchange to comply with the law or contract in taking an action under this subsection.
(4)
The Commissioner, in the Commissioner’s role as a member of the Board, may not participate in any matter that involves the alleged failure of the Exchange to comply with the law or contract in taking an action under this subsection if, in the Commissioner’s judgment, the Commissioner’s participation might create a conflict of interest with respect to the Commissioner’s regulatory authority over the Exchange’s taking an action under this subsection.
(d)
Except as provided in subsection (c) of this section, this section does not:
(1)
affect the Commissioner’s authority to regulate a carrier under this article; or
(2)
limit the authority of the Commissioner to take action against any person with respect to any provision of this article.
Md. Code Ann., Ins. § 31-104 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–104LinkCopy Citation
(a)
There is a Board of Trustees of the Exchange.
(b)
The Board consists of the following members:
(1)
the Secretary of Health;
(2)
the Commissioner;
(3)
the Executive Director of the Maryland Health Care Commission; and
(4)
the following members appointed by the Governor, with the advice and consent of the Senate:
(i)
three members who:
(1)
represent the interests of employers and individual consumers of products offered by the Exchange; and
(2)
may have public health research expertise; and
(ii)
three members who have demonstrated knowledge and expertise in at least two of the following areas:
(1)
individual health care coverage;
(2)
small employer–sponsored health care coverage;
(3)
health benefit plan administration;
(4)
health care finance;
(5)
administration of public or private health care delivery systems;
(6)
purchasing and facilitating enrollment in health plan coverage, including demonstrated knowledge and expertise about the role of licensed health insurance producers and third–party administrators in connecting employers and individual consumers to health plan coverage; and
(7)
public health and public health research, including knowledge about the health needs and health disparities among the State’s diverse communities.
(c)
In making appointments of members under subsection (b)(4) of this section, the Governor shall assure that:
(1)
the Board’s composition reflects a diversity of expertise;
(2)
the Board’s composition reflects the gender, racial, and ethnic diversity of the State; and
(3)
the geographic areas of the State are represented.
(d)
(1)
For purposes of this subsection, “affiliation” means:
(i)
a financial interest, as defined in § 5–101 of the General Provisions Article;
(ii)
a position of governance, including membership on a board of directors, regardless of compensation;
(iii)
a relationship through which compensation, as defined in § 5–101 of the General Provisions Article, is received; or
(iv)
a relationship for the provision of services as a regulated lobbyist, as defined in § 5–101 of the General Provisions Article.
(2)
A member of the Board or of the staff of the Exchange, while serving on the Board or the staff, may not have an affiliation with:
(i)
a carrier, an insurance producer, a third–party administrator, a managed care organization, or any other person contracting directly with the Exchange;
(ii)
a trade association of carriers, insurance producers, third–party administrators, or managed care organizations; or
(iii)
any other association of entities in a position to contract directly with the Exchange.
(e)
(1)
The term of a member appointed by the Governor is 4 years.
(2)
The terms of members appointed by the Governor are staggered as required by the terms provided for members of the Board on June 1, 2011.
(3)
At the end of a term, a member continues to serve until a successor is appointed and qualifies.
(4)
A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.
(f)
An appointed member of the Board may not serve more than two consecutive full terms.
(g)
The Governor shall designate a chair of the Board.
(h)
(1)
The Board shall determine the times, places, and frequency of its meetings.
(2)
Five members of the Board constitute a quorum.
(3)
Action by the Board requires the affirmative vote of at least five members.
(i)
A member of the Board is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.
(j)
A member shall:
(1)
meet the requirements of this subtitle, the Affordable Care Act, and all applicable State and federal laws and regulations;
(2)
serve the public interest of the individuals and qualified employers seeking health care coverage through the Exchange; and
(3)
ensure the sound operation and fiscal solvency of the Exchange.
(k)
A member of the Board shall perform the member’s duties:
(1)
in good faith;
(2)
in the manner the member reasonably believes to be in the best interests of the Exchange; and
(3)
without intentional or reckless disregard of the care an ordinarily prudent person in a like position would use under similar circumstances.
(l)
A member of the Board who performs the member’s duties in accordance with the standard provided in subsection (k) of this section may not be liable personally for actions taken as a member.
(m)
A member of the Board may be removed for incompetence, misconduct, or failure to perform the duties of the position.
(n)
(1)
(i)
A member of the Board shall be subject to the Maryland Public Ethics Law, Title 5, Subtitles 1 through 7 of the General Provisions Article.
(ii)
In addition to the disclosure required under Title 5, Subtitle 6 of the General Provisions Article, a member of the Board shall disclose to the Board and to the public any relationship not addressed in the required financial disclosure that the member has with a carrier, insurance producer, third–party administrator, managed care organization, or other entity in an industry involved in matters likely to come before the Board.
(2)
On all matters that come before the Board, the member shall:
(i)
adhere strictly to the conflict of interest provisions under Title 5, Subtitle 5 of the General Provisions Article relating to restrictions on participation, employment, and financial interests; and
(ii)
provide full disclosure to the Board and the public on:
(1)
any matter that gives rise to a potential conflict of interest; and
(2)
the manner in which the member will comply with the provisions of Title 5, Subtitle 5 of the General Provisions Article to avoid any conflict of interest or appearance of a conflict of interest.
Md. Code Ann., Ins. § 31-105 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–105LinkCopy Citation
(a)
(1)
With the approval of the Governor, the Board shall appoint an Executive Director of the Exchange.
(2)
The Executive Director shall serve at the pleasure of the Board.
(3)
The Board shall determine the appropriate compensation for the Executive Director.
(b)
Under the direction of the Board, the Executive Director shall:
(1)
be the chief administrative officer of the Exchange;
(2)
direct, administer, and manage the operations of the Exchange; and
(3)
perform all duties necessary to comply with and carry out the provisions of this subtitle, other State law and regulations, and the Affordable Care Act.
(c)
(1)
In accordance with the State budget, the Executive Director may employ and retain a staff for the Exchange.
(2)
(i)
The Executive Director may set the compensation of an Exchange employee in a position that:
(1)
is unique to the Exchange;
(2)
requires specific skills or experience to perform the duties of the position; and
(3)
does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government.
(ii)
The Secretary of Budget and Management, in consultation with the Executive Director, shall determine the positions for which the Executive Director may set compensation under subparagraph (i) of this paragraph.
(3)
Except as provided in paragraphs (4) and (5) of this subsection, or otherwise by law, the Executive Director’s appointment, retention, and removal of staff of the Exchange are not subject to Division I of the State Personnel and Pensions Article.
(4)
In hiring staff for functions that must be performed by State personnel under the Affordable Care Act or other applicable federal or State laws, the Executive Director’s appointment, retention, and removal of staff shall be in accordance with Division I of the State Personnel and Pensions Article.
(5)
In hiring staff for functions that have been and currently are performed by State personnel, the Executive Director’s appointment, retention, and removal of staff shall be in accordance with Division I of the State Personnel and Pensions Article.
(6)
Except as provided in paragraph (7) of this subsection, staff for all other positions necessary to carry out the purposes of this subtitle shall be positions in the executive service or management service, or special appointments of the skilled service or the professional service in the State Personnel Management System.
(7)
The Executive Director may retain as independent contractors, and set compensation for, attorneys, financial consultants, and any other professionals or consultants necessary to carry out the planning, development, and operations of the Exchange and the provisions of this subtitle.
(d)
The Executive Director shall determine the classification, grade, and compensation of those positions designated under subsection (c)(2) of this section:
(1)
in consultation with the Secretary of Budget and Management;
(2)
with the approval of the Board; and
(3)
when possible, in accordance with the State pay plan.
(e)
(1)
With respect to staff of the Exchange designated under subsection (c)(2) of this section, the Executive Director shall submit to the Secretary of Budget and Management, at least 45 days before the effective date of the change, each change to the Exchange’s salary plans that involves increases or decreases in salary ranges other than those associated with routine reclassifications and promotions or general salary increases approved by the General Assembly.
(2)
Reportable changes include:
(i)
the creation or abolition of classes;
(ii)
the regrading of classes from one established range to another; and
(iii)
the creation of new pay schedules or ranges.
(3)
The Secretary of Budget and Management shall:
(i)
review the proposed change; and
(ii)
at least 15 days before the effective date of the proposed change:
(1)
advise the Executive Director whether the change would have an adverse effect on comparable State jobs; and
(2)
if there would be an adverse effect, recommend an alternative change that would not have an adverse effect on comparable State jobs.
(4)
Failure of the Secretary of Budget and Management to respond in a timely manner is deemed to be agreement with the change as submitted.
(f)
Except as otherwise provided in this subtitle, an employee or independent contractor of the Exchange is not subject to any law, regulation, or executive order governing State compensation, including furloughs, pay cuts, or any other General Fund cost savings measure.
Md. Code Ann., Ins. § 31-106 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–106LinkCopy Citation
(a)
Subject to any limitations under this subtitle or other applicable law, the Board shall have all powers necessary or convenient to carry out the functions authorized by the Affordable Care Act and consistent with the purposes of the Exchange.
(b)
The enumeration of specific powers in this subtitle is not intended to restrict the Board’s power to take any lawful action that the Board determines is necessary or convenient to carry out the functions authorized by the Affordable Care Act and consistent with the purposes of the Exchange.
(c)
(1)
In addition to the powers set forth elsewhere in this subtitle, the Board may:
(i)
adopt and alter an official seal;
(ii)
sue, be sued, plead, and be impleaded;
(iii)
adopt bylaws, rules, and policies;
(iv)
subject to paragraph (2) of this subsection, adopt regulations to carry out this subtitle:
(1)
in accordance with Title 10, Subtitle 1 of the State Government Article; and
(2)
without conflicting with or preventing application of regulations adopted by the Secretary under Title 1, Subtitle D of the Affordable Care Act;
(v)
maintain an office at the place designated by the Board;
(vi)
enter into any agreements or contracts and execute the instruments necessary or convenient to manage its own affairs and carry out the purposes of this subtitle;
(vii)
apply for and receive grants, contracts, or other public or private funding; and
(viii)
do all things necessary or convenient to carry out the powers granted by this subtitle.
(2)
Unless waived by the chairs of the committees, at least 30 days before submitting any proposed regulation to the Maryland Register for publication, the Board shall submit the proposed regulation to the Senate Finance Committee and the House Health Committee.
(d)
(1)
To carry out the purposes of this subtitle or perform any of its functions under this subtitle, the Board may contract or enter into memoranda of understanding with eligible entities, including:
(i)
the Maryland Medical Assistance Program;
(ii)
the family investment unit of the Department of Human Services;
(iii)
insurance producers and third party administrators registered in the State; and
(iv)
any other entities that have experience in individual and small group public and private health insurance plans or facilitating enrollment in those plans.
(2)
The operations of the Exchange are subject to the provisions of this subtitle whether the operations are performed directly by the Exchange or through an entity under a contract with the Exchange.
(3)
The Board shall ensure that any entity under a contract with the Exchange complies with the provisions of this subtitle when performing services that are subject to this subtitle on behalf of the Exchange.
(e)
(1)
The Board may enter into information–sharing agreements with federal and state agencies, and other state health insurance exchanges, to carry out the provisions of this subtitle.
(2)
An information–sharing agreement entered into under paragraph (1) of this subsection shall:
(i)
include adequate protections with respect to the confidentiality of information; and
(ii)
comply with all State and federal laws and regulations.
(f)
(1)
The Board, in accordance with Title 12, Subtitle 4 of the State Finance and Procurement Article, shall adopt written policies and procedures governing all procurements of the Exchange.
(2)
To the fullest extent practicable, and in a manner that does not impair the Exchange’s ability to carry out the purposes of this subtitle, the Board’s procurement policies and procedures shall establish an open and transparent process that:
(i)
promotes public confidence in the procurements of the Exchange;
(ii)
ensures fair and equitable treatment of all persons and entities that participate in the procurement system of the Exchange;
(iii)
fosters appropriate competition and provides safeguards for maintaining a procurement system of quality and integrity;
(iv)
promotes increased economic efficiency and responsibility on the part of the Exchange;
(v)
achieves the maximum benefit from the purchasing power of the Exchange; and
(vi)
provides clarity and simplicity in the rules and procedures governing the procurements of the Exchange.
(g)
(1)
To carry out the purposes of this subtitle, the Board shall:
(i)
create and consult with ad hoc advisory committees; and
(ii)
appoint to the ad hoc advisory committees representatives of:
(1)
insurers or health maintenance organizations offering health benefit plans in the State;
(2)
nonprofit health service plans offering health benefit plans in the State;
(3)
licensed health insurance producers and advisers;
(4)
third–party administrators;
(5)
health care providers, including:
(A)
hospitals;
(B)
long–term care facilities;
(C)
mental health providers;
(D)
developmental disability providers;
(E)
substance abuse treatment providers;
(F)
Federally Qualified Health Centers;
(G)
physicians;
(H)
nurses;
(I)
experts in services and care coordination for criminal and juvenile justice populations;
(J)
licensed hospice providers; and
(K)
other health care professionals;
(6)
managed care organizations;
(7)
employers, including large, small, and minority–owned employers;
(8)
public employee unions, including public employee union members who are caseworkers in local departments of social services with direct knowledge of information technology systems used for Medicaid eligibility determination;
(9)
consumers, including individuals who:
(A)
reside in lower–income and racial or ethnic minority communities;
(B)
have chronic diseases or disabilities; or
(C)
belong to other hard–to–reach or special populations;
(10)
individuals with knowledge and expertise in advocacy for consumers described in item 9 of this item;
(11)
public health researchers and other academic experts with knowledge and background relevant to the functions and goals of the Exchange, including knowledge of the health needs and health disparities among the State’s diverse communities; and
(12)
any other stakeholders identified by the Exchange as having knowledge or representing interests relevant to the functions and duties of the Exchange.
(2)
In addition to the ad hoc advisory committees created under paragraph (1) of this subsection, the Board, on or before March 15, 2014, shall create a standing advisory committee that:
(i)
consists of members who, to the extent practicable:
(1)
reflect the gender, racial, ethnic, and geographic diversity of the State;
(2)
constitute a diverse cross–section of stakeholders broadly representative of the individuals and entities described in paragraph (1)(ii) of this subsection; and
(3)
are appointed by the Board for a term of no more than 3 years in a manner that provides continuity and rotation;
(ii)
has a liaison to the Board who is a member of the Board and is appointed by the chair of the Board; and
(iii)
is charged with the responsibility of addressing the broad range of policy issues:
(1)
on which the Board may seek its input and advice; and
(2)
that may be proposed by the liaison to the Board, in consultation with the standing advisory committee chair and members.
Md. Code Ann., Ins. § 31-107 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–107LinkCopy Citation
(a)
There is a Maryland Health Benefit Exchange Fund.
(b)
(1)
The purpose of the Fund is to:
(i)
provide funding for the operation and administration of the Exchange in carrying out the purposes of the Exchange under this subtitle;
(ii)
provide funding for the establishment and operation of the State Reinsurance Program authorized under this subtitle;
(iii)
provide funding for the Medical Assistance Program and the Senior Prescription Drug Assistance Program;
(iv)
provide funding for the establishment and operation of Health Equity Resource Communities under Title 20, Subtitle 14 of the Health – General Article;
(v)
provide funding for the establishment and operation of the State–Based Young Adult Health Insurance Subsidies Program authorized under this subtitle; and
(vi)
provide funding for the establishment of State–based health insurance subsidies to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii).
(2)
The operation and administration of the Exchange, the State Reinsurance Program, the State–Based Young Adult Health Insurance Subsidies Program, and the Qualified Resident Enrollment Program may include functions delegated by the Exchange to a third party under law or by contract.
(c)
The Exchange shall administer the Fund.
(d)
(1)
The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.
(2)
The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.
(e)
The Fund consists of:
(1)
any user fees or other assessments collected by the Exchange;
(2)
all revenue deposited into the Fund that is received from the distribution of the premium tax under § 6–103.2 of this article;
(3)
income from investments made on behalf of the Fund;
(4)
interest on deposits or investments of money in the Fund;
(5)
money collected by the Board as a result of legal or other actions taken by the Board on behalf of the Exchange or the Fund;
(6)
money donated to the Fund;
(7)
money awarded to the Fund through grants;
(8)
any pass–through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act;
(9)
any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State;
(10)
any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State;
(11)
any funds designated by the State to provide State–based health insurance subsidies to young adults in the State;
(12)
any funds designated by the State to provide State–based health insurance subsidies to individuals in the State to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii);
(13)
any federal funds received in accordance with § 31–121 of this subtitle for the administration of small business tax credits; and
(14)
any other money from any other source accepted for the benefit of the Fund.
(f)
(1)
The Fund may be used only:
(i)
(1)
for the operation and administration of the Exchange in carrying out the purposes authorized under this subtitle;
(2)
for the establishment and operation of the State Reinsurance Program; and
(3)
for appropriations to the Health Equity Resource Community Reserve Fund under § 20–1407 of the Health – General Article;
(ii)
in fiscal years 2021 and 2022, for the Medical Assistance Program within the Medical Care Programs Administration of the Maryland Department of Health;
(iii)
in fiscal year 2022, for the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health – General Article;
(iv)
for the establishment and operation of the State–Based Young Adult Health Insurance Subsidies Program; and
(v)
in fiscal years 2026 through 2028, for the establishment of State–based health insurance subsidies to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii).
(2)
In each of fiscal years 2023 through 2025, the Governor shall:
(i)
transfer $15,000,000 to the Health Equity Resource Community Reserve Fund; and
(ii)
include the funds transferred in accordance with item (i) of this paragraph in the annual budget bill as an appropriation to the Health Equity Resource Community Reserve Fund under § 20–1407 of the Health – General Article.
(g)
(1)
The Board shall maintain separate accounts within the Fund for Exchange operations, for the State Reinsurance Program, and for the State–Based Young Adult Health Insurance Subsidies Program.
(2)
Accounts within the Fund shall contain the money that is intended to support the purpose for which each account is designated.
(3)
Funds received from the distribution of the premium tax under § 6–103.2 of this article shall be placed in the account for Exchange operations and may be used only for the purpose of funding the operation and administration of the Exchange.
(4)
The following funds may be used only for the purposes of funding the State Reinsurance Program:
(i)
any pass–through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to carriers that offer individual health benefit plans in the State;
(ii)
any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; and
(iii)
any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State.
(5)
Except as provided in subsection (f) of this section, funds received from the distribution of the assessment under § 6–102.1 of this article may be used only for purposes of funding the State Reinsurance Program and the State–Based Health Insurance Subsidies Program.
(h)
(1)
Expenditures from the Fund for the purposes authorized by this subtitle may be made only:
(i)
with an appropriation from the Fund approved by the General Assembly in the State budget; or
(ii)
by the budget amendment procedure provided for in Title 7, Subtitle 2 of the State Finance and Procurement Article.
(2)
Notwithstanding § 7–304 of the State Finance and Procurement Article, if the amount of the distribution from the premium tax under § 6–103.2 of this article exceeds in any State fiscal year the actual expenditures incurred for the operation and administration of the Exchange, funds in the Exchange operations account from the premium tax that remain unspent at the end of the State fiscal year shall revert to the General Fund of the State.
(3)
If operating expenses of the Exchange may be charged to either State or non–State fund sources, the non–State funds shall be charged before State funds are charged.
(i)
(1)
The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.
(2)
Any investment earnings of the Fund shall be credited to the Fund.
(3)
Except as provided in subsection (h)(2) of this section, no part of the Fund may revert or be credited to the General Fund or any special fund of the State.
(j)
A debt or an obligation of the Fund is not a debt of the State or a pledge of credit of the State.
Md. Code Ann., Ins. § 31-107.1 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–107.1LinkCopy Citation
(a)
The Board shall establish a trust account to hold premium payments accepted from qualified plan enrollees and small employers by the Exchange on behalf of a carrier under contract or other agreement.
(b)
The trust account may be used only to hold a premium payment until the Exchange transmits the premium payment to the carrier on whose behalf the Exchange accepted the premium payment.
(c)
The Exchange shall maintain separate records of account for each carrier on whose behalf it accepts premium payments.
(d)
The payment of a premium by an enrollee or a small employer to the Exchange is deemed to be a payment to the carrier on whose behalf the Exchange accepted the premium payment.
Md. Code Ann., Ins. § 31-107.2 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–107.2LinkCopy Citation
(a)
(1)
For State fiscal year 2015 and for each State fiscal year thereafter, from the funds received from the distribution of the premium tax under § 6–103.2 of this article, the Governor shall provide an appropriation in the State budget adequate to fully fund the operations of the Exchange.
(2)
(i)
For State fiscal year 2015, the appropriation shall be no less than $10,000,000.
(ii)
For State fiscal year 2021, the appropriation shall be $31,500,000.
(iii)
For State fiscal year 2022 and each fiscal year thereafter, the appropriation shall be $32,000,000.
(b)
Funds allocated from the premium tax under subsection (a) of this section to provide the appropriation to the Exchange may be used only for the purpose of funding the operation and administration of the Exchange.
(c)
If, in any State fiscal year, the amount of the allocation from the premium tax is insufficient to meet the actual expenditures incurred for the operation and administration of the Exchange, the Governor may provide an additional appropriation by deficiency appropriation.
(d)
Notwithstanding § 7–304 of the State Finance and Procurement Article, funds allocated to the Exchange under this section that remain unspent at the end of a fiscal year shall revert to the General Fund of the State.
Md. Code Ann., Ins. § 31-108 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–108LinkCopy Citation
(a)
On or before January 1, 2014, the functions and operations of the Exchange shall include at a minimum all functions required by § 1311(d)(4) of the Affordable Care Act.
(b)
In compliance with § 1311(d)(4) of the Affordable Care Act, the Exchange shall:
(1)
make qualified plans available to qualified individuals, qualified residents, and qualified employers;
(2)
allow a carrier to offer a qualified dental plan through the Exchange that provides limited scope dental benefits that meet the requirements of § 9832(c)(2)(A) of the Internal Revenue Code, either separately, in conjunction with, or as an endorsement to a qualified health plan, provided that the qualified health plan provides pediatric dental benefits that meet the requirements of § 1302(b)(1)(J) of the Affordable Care Act;
(3)
allow a carrier to offer a qualified vision plan through the Exchange that provides limited scope vision benefits that meet the requirements of § 9832(c)(2)(A) of the Internal Revenue Code, either separately, in conjunction with, or as an endorsement to a qualified health plan, provided that the qualified health plan provides pediatric vision benefits that meet the requirements of § 1302(b)(1)(J) of the Affordable Care Act;
(4)
consistent with the guidelines developed by the Secretary under § 1311(c) of the Affordable Care Act, implement procedures for the certification, recertification, and decertification of:
(i)
health benefit plans as qualified health plans;
(ii)
dental plans as qualified dental plans; and
(iii)
vision plans as qualified vision plans;
(5)
provide for the operation of a toll–free telephone hotline to respond to requests for assistance;
(6)
provide for initial, annual, and special enrollment periods, in accordance with guidelines adopted by the Secretary under § 1311(c)(6) of the Affordable Care Act;
(7)
maintain a website through which enrollees and prospective enrollees of qualified plans may obtain standardized comparative information on qualified health plans, qualified dental plans, and qualified vision plans;
(8)
with respect to each qualified plan offered through the Exchange:
(i)
assign a rating to each qualified plan in accordance with the criteria developed by the Secretary under § 1311(c)(3) of the Affordable Care Act and any additional criteria that may be applicable under the laws of the State and regulations adopted by the Exchange under this subtitle; and
(ii)
determine each qualified health plan’s coverage level in accordance with regulations adopted by the Secretary under § 1302(d)(2)(A) of the Affordable Care Act and any additional regulations adopted by the Exchange under this subtitle;
(9)
(i)
present qualified plan options offered by the Exchange in a standardized format, including the use of the uniform outline of coverage established under § 2715 of the federal Public Health Service Act; and
(ii)
to the extent necessary, modify the standardized format to accommodate differences in qualified health plan, qualified dental plan, and qualified vision plan options;
(10)
in accordance with § 1413 of the Affordable Care Act, provide information and make determinations regarding eligibility for the following programs:
(i)
the Maryland Medical Assistance Program under Title XIX of the Social Security Act;
(ii)
the Maryland Children’s Health Program under Title XXI of the Social Security Act; and
(iii)
any applicable State or local public health insurance program;
(11)
facilitate the enrollment of any individual who the Exchange determines is eligible for a program described in item (10) of this subsection;
(12)
establish and make available by electronic means a calculator to determine the actual cost of coverage of a qualified plan offered by the Exchange after application of any premium tax credit under § 36B of the Internal Revenue Code and any cost–sharing reduction under § 1402 of the Affordable Care Act;
(13)
in accordance with this subtitle, establish a SHOP Exchange through which qualified employers may access coverage for their employees at specified coverage levels and meet standards for the federal qualified employer tax credit;
(14)
implement a certification process for individuals exempt from the individual responsibility requirement and penalty under § 5000A of the Internal Revenue Code on the grounds that:
(i)
no affordable qualified health plan that covers the individual is available through the Exchange or the individual’s employer; or
(ii)
the individual meets other requirements under the Affordable Care Act that make the individual eligible for the exemption;
(15)
implement a process for transfer to the United States Secretary of the Treasury the name and taxpayer identification number of each individual who:
(i)
is certified as exempt from the individual responsibility requirement;
(ii)
is employed but determined eligible for the premium tax credit on the grounds that:
(1)
the individual’s employer does not provide minimum essential coverage; or
(2)
the employer’s coverage is determined to be unaffordable for the individual or does not provide the requisite minimum actuarial value;
(iii)
notifies the Exchange under § 1411(b)(4) of the Affordable Care Act that the individual has changed employers; or
(iv)
ceases coverage under a qualified health plan during the plan year, together with the date coverage ceased;
(16)
provide notice to employers of employees who cease coverage under a qualified health plan during a plan year, together with the date coverage ceased;
(17)
conduct processes required by the Secretary and the United States Secretary of the Treasury to determine eligibility for premium tax credits, reduced cost–sharing, and individual responsibility requirement exemptions;
(18)
establish a Navigator Program in accordance with § 1311(i) of the Affordable Care Act and this subtitle;
(19)
carry out a plan to provide appropriate assistance for consumers seeking to purchase products through the Exchange, including the implementation of:
(i)
a navigator program for the SHOP Exchange and a navigator program for the Individual Exchange; and
(ii)
the toll–free hotline required under item (5) of this subsection;
(20)
carry out a public relations and advertising campaign to promote the Exchange;
(21)
conduct outreach and education activities to increase health literacy and to educate consumers about the Exchange and insurance affordability programs that:
(i)
include minority populations;
(ii)
do not include clinical or individual health information related to a specific health condition; and
(iii)
increase participation in the Exchange; and
(22)
perform administrative, technological, operational, and reporting functions for Maryland Medical Assistance programs, as requested by the Maryland Department of Health and approved by the Board, to the extent that the performance of the functions aid in the efficient operations of the Exchange and the Maryland Medical Assistance programs.
(c)
(1)
In carrying out the functions under subsections (a) and (b) of this section, the Exchange shall comply with § 508 of the federal Rehabilitation Act of 1973 and any regulations adopted under § 508 of the Act.
(2)
The obligation for the Exchange to comply with § 508 of the federal Rehabilitation Act of 1973 does not affect any other requirements relating to accessibility for persons with disabilities to which the Exchange may be subject under the federal Americans with Disabilities Act of 1990.
(d)
If an individual enrolls in another type of minimum essential coverage, neither the Exchange nor a carrier offering qualified health plans through the Exchange may charge the individual a fee or penalty for termination of coverage on the grounds that:
(1)
the individual has become newly eligible for that coverage; or
(2)
the individual’s employer–sponsored coverage has become affordable under the standards of § 36B(c)(2)(C) of the Internal Revenue Code.
(e)
The Exchange, through the advisory committees established under § 31–106(g) of this subtitle or through other means, shall consult with and consider the recommendations of the stakeholders represented on the advisory committees in the exercise of its duties under this subtitle.
(f)
The Exchange may not make available:
(1)
any health benefit plan that is not a qualified health plan;
(2)
any dental plan that is not a qualified dental plan; or
(3)
any vision plan that is not a qualified vision plan.
(g)
The Exchange shall provide the advance directive information sheet developed under § 5–615 of the Health – General Article:
(1)
in the Exchange’s consumer publications;
(2)
on the Exchange’s website; and
(3)
at the request of an applicant.
(h)
(1)
The Exchange shall open a special or other enrollment period for an individual who consents to share information through the system implemented in accordance with § 8–109(b)(1) of the Labor and Employment Article.
(2)
The enrollment period opened under paragraph (1) of this subsection shall:
(i)
apply to qualified health plans offered through the Exchange in the individual market;
(ii)
begin on the date the Exchange sends notice to the individual;
(iii)
last for a period of time determined by the Exchange and that is at least 30 days; and
(iv)
be available to an individual described in paragraph (1) of this subsection and to the individual’s dependent as defined in 45 C.F.R. § 155.420.
(3)
The Exchange may conduct outreach to an individual described in paragraph (1) of this subsection using methods that include:
(i)
written notices;
(ii)
contact through telephonic and electronic means; and
(iii)
the provision of individualized assistance by insurance agents and brokers, navigators, and Exchange contractors and staff.
Md. Code Ann., Ins. § 31-109 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–109LinkCopy Citation
(a)
Subject to subsection (b) of this section, the Exchange may enter into agreements or memoranda of understanding with another state to:
(1)
develop joint or reciprocal certification processes;
(2)
develop consistency in qualified plans offered across states; and
(3)
coordinate resources for administrative processes necessary to support:
(i)
certification of qualified plans; and
(ii)
other functions of the Exchange.
(b)
Any interstate agreements or memoranda of understanding entered into under subsection (a) of this section shall comply with and advance:
(1)
the purposes and requirements of this subtitle and the Affordable Care Act; and
(2)
the policies and regulations adopted by the Exchange under this subtitle.
Md. Code Ann., Ins. § 31-110 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–110LinkCopy Citation
(a)
In making qualified plans available to individuals and employers through contracts with carriers, the Exchange first shall seek to:
(1)
achieve a robust and stable enrollment in the Exchange; and
(2)
decrease the number of State residents without health insurance coverage.
(b)
(1)
Subject to subsection (e) of this section, the Exchange, with the market impact and leverage attained through a robust and stable enrollment, may use alternative contracting options and active purchasing strategies to increase affordability and quality of care for consumers and lower costs in the health care system overall.
(2)
The Exchange’s efforts to increase affordability and quality of care and to lower costs may include pursuing key objectives such as higher standards of care, continuity of care, delivery system reforms, health equity, improved patient experience and outcomes, and meaningful cost controls within the health care system.
(c)
In employing contracting strategies to implement this section, the Exchange shall consider, on a continuing basis, the need to balance:
(1)
the importance of sufficient enrollment and carrier participation to ensure the Exchange’s success and long–term viability; and
(2)
its progress in achieving the key objectives stated in subsection (b)(2) of this section.
(d)
Beginning January 1, 2014, the Exchange:
(1)
shall allow any qualified plans that meet the minimum standards established by the Exchange under this subtitle to be offered in the Exchange; and
(2)
may exercise its authority under § 31–115(b)(9) of this subtitle to establish minimum standards for qualified plans in addition to those required by the Affordable Care Act.
(e)
Subject to subsections (f) and (g) of this section, beginning January 1, 2016, in addition to establishing minimum standards for qualified plans, the Exchange may employ alternative contracting options and active purchasing strategies, including:
(1)
competitive bidding;
(2)
negotiation with carriers to achieve optimal participation and plan offerings in the Exchange; and
(3)
partnering with carriers to promote choice and affordability for individuals and small employers among qualified plans offering high value, patient–centered, team–based care, value–based insurance design, and other high quality and affordable options.
(f)
During any year in which the Exchange employs alternative contracting options and active purchasing strategies, the participation requirements set forth in §§ 15–1204.1(b) and 15–1303(b) of this article for carriers in the individual and small group markets outside the Exchange shall be suspended.
(g)
Before employing an alternative contracting option or active purchasing strategy, the Exchange:
(1)
on or after December 1, but not later than the first day of the next regular session of the General Assembly, shall submit to the Senate Finance Committee and the House Health Committee, in accordance with § 2–1257 of the State Government Article, a plan for the use of the alternative contracting option or active purchasing strategy, including an analysis of:
(i)
the objectives to be achieved through use of the alternative contracting option or active purchasing strategy; and
(ii)
the impact on the insurance markets inside and outside the Exchange and on consumers; and
(2)
shall allow the committees to have 90 days for review and comment.
Md. Code Ann., Ins. § 31-111 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–111LinkCopy Citation
(a)
The SHOP Exchange:
(1)
shall be a separate insurance market within the Exchange for small employers; and
(2)
may not be merged with the individual market of the Individual Exchange.
(b)
The SHOP Exchange shall be designed to balance:
(1)
the viability of the SHOP Exchange as an alternative for qualified employers and their employees who have not been able historically to access and afford insurance in the small group market;
(2)
the need for stability and predictability in employers’ health insurance costs incurred on behalf of their employees;
(3)
the desirability of providing employees with a meaningful choice among high–quality and affordable health benefit plans; and
(4)
the need to facilitate continuity of care for employees who change employers or health benefit plans.
(c)
The SHOP Exchange shall allow qualified employers to:
(1)
as required by regulations adopted by the Secretary under the Affordable Care Act, designate a coverage level within which their employees may choose any qualified health plan; or
(2)
designate a carrier or an insurance holding company system, as defined in § 7–101 of this article, and a menu of qualified health plans offered by the carrier or the insurance holding company system in the SHOP Exchange from which their employees may choose.
(d)
In addition to the options set forth in subsection (c) of this section, the SHOP Exchange also may allow qualified employers to designate one or more qualified dental plans and qualified vision plans to be made available to their employees.
(e)
(1)
A qualified employer is not required to contribute to the qualified plan premiums of its employees.
(2)
(i)
If a qualified employer chooses to contribute to the qualified plan premiums of its employees, the qualified employer shall:
(1)
select a reference plan on which the contributions will be based; and
(2)
make a contribution that is:
(A)
a fixed percentage of the premium of the reference plan, based on the coverage level selected by the member and the member’s job classification, if otherwise permissible; or
(B)
a dollar amount that ensures that all of the qualified employer’s employees with the same coverage level and job classification would pay the same amount if they purchased the reference plan.
(ii)
A reference plan selected under subparagraph (i)1 of this paragraph:
(1)
under the employer choice model, shall be a qualified plan that is:
(A)
offered by the carrier or insurance holding company system selected by the qualified employer; and
(B)
among the qualified plans of the carrier or insurance holding company system selected by the qualified employer; or
(2)
under the employee choice model, shall be a qualified plan offered by any carrier at the metal level selected by the qualified employer.
(f)
On or after January 1, 2016, in order to continue to promote the SHOP Exchange’s principles of accessibility, choice, affordability, and sustainability, and as it obtains more data on adverse selection, cost, enrollment, and other factors, the SHOP Exchange:
(1)
may reassess and modify the manner in which the SHOP Exchange allows qualified employers to offer, and their employees to choose, qualified health plans and coverage levels;
(2)
in reassessing employer and employee choice, may consider options which would promote the additional objective of increasing the portability of employees’ health insurance as employees move from employer to employer or transition in and out of employment; and
(3)
shall implement any modification of offerings and choice through regulations adopted by the SHOP Exchange.
Md. Code Ann., Ins. § 31-112 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–112LinkCopy Citation
(a)
There is a navigator program for the SHOP Exchange.
(b)
The navigator program for the SHOP Exchange shall focus outreach efforts and provide health insurance enrollment and eligibility services to small employers that do not offer health insurance to their employees.
(c)
(1)
To carry out its purpose and in compliance with the Affordable Care Act, the SHOP Exchange navigator program, with respect only to qualified plans offered in the SHOP Exchange, shall provide comprehensive consumer assistance services, including:
(i)
conducting education and outreach to small employers;
(ii)
distributing information about the SHOP Exchange, including information about:
(1)
options with respect to employer and employee choice;
(2)
procedures for enrolling in qualified plans; and
(3)
the availability of applicable tax credits;
(iii)
facilitating:
(1)
qualified plan selection, based on the needs of the employee;
(2)
application processes;
(3)
enrollment;
(4)
renewals; and
(5)
disenrollment;
(iv)
conducting eligibility determinations and redeterminations for tax credits;
(v)
providing referrals to appropriate agencies, including the Attorney General’s Health Education and Advocacy Unit and the Administration, for applicants and enrollees with grievances, complaints, or questions;
(vi)
providing all information and services in a manner that is culturally and linguistically appropriate and ensures accessibility for individuals with disabilities; and
(vii)
providing ongoing support with respect to the functions set forth in this section, including eligibility and enrollment and disenrollment in and renewal of qualified plans offered in the SHOP Exchange.
(2)
A SHOP Exchange navigator:
(i)
shall hold a SHOP Exchange navigator license issued under subsection (d) of this section;
(ii)
may not be required to hold an insurance producer license;
(iii)
shall be engaged by and receive compensation only through the SHOP Exchange;
(iv)
may not receive compensation from or otherwise be affiliated with a carrier, an insurance producer, a third–party administrator, or any other person connected to the insurance industry; and
(v)
shall complete and comply with any ongoing requirements of the training program established under subsection (h) of this section.
(3)
With respect to the insurance market outside the Exchange, a SHOP Exchange navigator:
(i)
may not provide any information or services related to health benefit plans or other products not offered in the Exchange, except for general information about the insurance market outside the Exchange, which shall be limited to the information provided in a consumer education document developed by the Exchange and the Commissioner;
(ii)
shall refer any inquiries about health benefit plans or other products not offered in the Exchange to:
(1)
any resources that may be maintained by the Exchange; or
(2)
carriers and licensed insurance producers;
(iii)
may not seek to replace any health benefit plan already offered by a small employer unless the small employer is eligible for a federal tax credit available only through the SHOP Exchange; and
(iv)
shall refer to the Individual Exchange navigator program any inquiries about information or services related to:
(1)
qualified plans offered in the Individual Exchange; or
(2)
the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
(d)
(1)
The Commissioner shall issue a SHOP Exchange navigator license to each applicant who meets the requirements of this subsection.
(2)
To qualify for a SHOP Exchange navigator license, an applicant:
(i)
shall be of good character and trustworthy;
(ii)
shall be at least 18 years old;
(iii)
shall pass a written examination given by the Commissioner under this subsection; and
(iv)
may not have committed any act that the Commissioner finds would warrant suspension or revocation of a license under subsection (e) of this section.
(3)
The Commissioner shall adopt regulations that govern:
(i)
the scope, type, conduct, frequency, and assessment of the written examination required for a license;
(ii)
the experience required for an individual applicant to be eligible to take the written examination; and
(iii)
the reinstatement of an expired license.
(e)
(1)
The Commissioner may deny, suspend, revoke, or refuse to renew or reinstate a SHOP Exchange navigator license after notice and opportunity for a hearing under §§ 2–210 through 2–214 of this article, if the licensee:
(i)
has willfully violated this article or any regulation adopted under this article;
(ii)
has intentionally misrepresented or concealed a material fact in the application for the license;
(iii)
has obtained the license by misrepresentation, concealment, or other fraud;
(iv)
has engaged in fraudulent or dishonest practices in conducting activities under the license;
(v)
has misappropriated, converted, or unlawfully withheld money in conducting activities under the license;
(vi)
has failed or refused to pay over on demand money that belongs to a person entitled to the money;
(vii)
has willfully and materially misrepresented the provisions of a qualified plan;
(viii)
has been convicted of a felony, a crime of moral turpitude, or any criminal offense involving dishonesty or breach of trust;
(ix)
has failed an examination required by this article or regulations adopted under this article;
(x)
has forged another’s name on an application for a qualified plan or on any other document in conducting activities under the license;
(xi)
has otherwise shown a lack of trustworthiness or competence to act as a SHOP Exchange navigator; or
(xii)
has willfully failed to comply with or violated a proper order or subpoena of the Commissioner.
(2)
Instead of or in addition to suspending or revoking a license, the Commissioner may:
(i)
impose a penalty of not less than $100 but not exceeding $500 for each violation of this article; and
(ii)
require that restitution be made to any person who has suffered financial injury because of a violation of this article.
(3)
If the Commissioner suspends a SHOP Exchange navigator license, the Commissioner may require the individual to pass an examination and file a new application before the suspension is lifted.
(4)
The penalties available to the Commissioner under this subsection shall be in addition to any criminal or civil penalties imposed for fraud or other misconduct under any other State or federal law.
(5)
The Commissioner shall notify the SHOP Exchange of any decision affecting the license of a SHOP Exchange navigator or any sanction imposed on a SHOP Exchange navigator under this subsection.
(6)
The Commissioner, in the Commissioner’s role as a member of the Board, may not participate in any matter that involves the SHOP Exchange’s navigator program if, in the Commissioner’s judgment, the Commissioner’s participation might create a conflict of interest with respect to the Commissioner’s regulatory authority over the SHOP Exchange’s navigator program.
(7)
A carrier is not responsible for the activities and conduct of a SHOP Exchange navigator.
(f)
(1)
The SHOP Exchange shall establish and administer an insurance producer authorization program.
(2)
Under the program, the SHOP Exchange shall:
(i)
provide an authorization to sell qualified plans to a licensed insurance producer who meets the requirements in subsection (g) of this section; and
(ii)
require renewal of an authorization every 2 years.
(3)
(i)
Subject to the contested case hearing provisions of Title 10, Subtitle 2 of the State Government Article, the SHOP Exchange may suspend, revoke, or refuse to renew an authorization for good cause, which shall include a finding that the insurance producer holding the authorization has committed any act described in subsection (e)(1) of this section with respect to the authorization.
(ii)
The SHOP Exchange shall notify the Commissioner of any decision affecting the status of an insurance producer’s authorization.
(4)
The SHOP Exchange, in consultation with the Commissioner, shall adopt regulations to carry out this subsection.
(g)
(1)
Subject to the requirements in paragraph (2) of this subsection, an insurance producer who is licensed in the State and authorized by the Commissioner to sell, solicit, or negotiate health insurance may sell any qualified plan offered in the SHOP Exchange without being separately licensed as a SHOP Exchange navigator.
(2)
To sell qualified plans in the SHOP Exchange, an insurance producer shall:
(i)
register and apply for an authorization from the SHOP Exchange;
(ii)
complete and comply with any ongoing requirements of the training program established under subsection (h) of this section; and
(iii)
in providing assistance to a small employer seeking information about offering health insurance, inform the small employer of:
(1)
all qualified health plans available to employees in the SHOP Exchange; and
(2)
all options available to the small employer in the SHOP Exchange for offering qualified health plans to employees.
(3)
An insurance producer:
(i)
may not be compensated by the SHOP Exchange for the sale of a qualified plan offered in the SHOP Exchange; and
(ii)
shall be compensated directly by a carrier.
(h)
(1)
The SHOP Exchange, with the approval of the Commissioner and in consultation with stakeholders, shall develop, implement, and, as appropriate, update training programs for:
(i)
SHOP Exchange navigators;
(ii)
licensed insurance producers who seek authorization to sell qualified plans in the SHOP Exchange; and
(iii)
Consolidated Services Center employees required to hold a SHOP Exchange enrollment permit.
(2)
The training programs shall:
(i)
impart the skills and expertise necessary to perform functions specific to the SHOP Exchange, such as making tax credit eligibility determinations; and
(ii)
enable the SHOP Exchange’s navigator program and the Consolidated Services Center to provide robust protection of consumers and adherence to high quality assurance standards.
Md. Code Ann., Ins. § 31-113 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–113LinkCopy Citation
(a)
(1)
There is a navigator program for the Individual Exchange.
(2)
The navigator program for the Individual Exchange shall be:
(i)
administered by the Individual Exchange; and
(ii)
regulated by the Commissioner.
(3)
In administering the navigator program, the Individual Exchange shall consult with the Commissioner and the Maryland Department of Health to ensure consistency and compliance with all laws, regulations, and policies governing:
(i)
the sale, solicitation, and negotiation of health insurance; and
(ii)
the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
(4)
In regulating the navigator program, the Commissioner shall enter into one or more memoranda of understanding with the Exchange and the Maryland Department of Health to facilitate enforcement of this section.
(5)
The Commissioner may require the Individual Exchange to:
(i)
make available to the Commissioner all records, documents, data, and other information relating to the navigator program, including the authorization of Individual Exchange connector entities and the certification of Individual Exchange navigators; and
(ii)
submit a corrective plan to take appropriate action to address any problems or deficiencies identified by the Commissioner in the Individual Exchange connector entity authorization process or the Individual Exchange navigator certification process.
(6)
The Commissioner, in the Commissioner’s role as a member of the Board, may not participate in any matter that involves the Individual Exchange’s navigator program if, in the Commissioner’s judgment, the Commissioner’s participation might create a conflict of interest with respect to the Commissioner’s regulatory authority over the Individual Exchange’s navigator program.
(b)
The navigator program for the Individual Exchange shall:
(1)
focus outreach efforts and services on individuals without health insurance coverage;
(2)
use Individual Exchange connector entities that:
(i)
have expertise in working with vulnerable and hard–to–reach populations; and
(ii)
conduct outreach and provide enrollment support for these populations; and
(3)
enable the Individual Exchange to:
(i)
comply with the Affordable Care Act by providing seamless entry into the Maryland Medical Assistance Program, the Maryland Children’s Health Program, and qualified plans;
(ii)
assist individuals who, due to former incarceration or other circumstances, transition between the types of coverage described in item (i) of this item or have lapsed enrollment; and
(iii)
meet consumer needs and demands for health insurance coverage while maintaining high standards of quality assurance and consumer protection.
(c)
To carry out its purposes and in compliance with the Affordable Care Act, the Individual Exchange navigator program, with respect only to the Maryland Medical Assistance Program, the Maryland Children’s Health Program, and qualified plans offered in the Exchange, shall provide comprehensive consumer assistance services, including:
(1)
conducting education and outreach to individuals;
(2)
distributing information about:
(i)
the Individual Exchange, including eligibility requirements for applicable federal premium subsidies and cost–sharing assistance;
(ii)
eligibility requirements for the Maryland Medical Assistance Program and the Maryland Children’s Health Program; and
(iii)
procedures for enrolling in the Maryland Medical Assistance Program, the Maryland Children’s Health Program, or qualified plans offered in the Individual Exchange;
(3)
with respect to qualified plans, facilitating:
(i)
plan selection, based on the needs of the individual seeking to enroll;
(ii)
assessment of tax implications and premium and cost–sharing requirements; and
(iii)
application, enrollment, renewal, and disenrollment processes;
(4)
facilitating eligibility determinations for the Maryland Medical Assistance Program and the Maryland Children’s Health Program, selection of managed care organizations, and application, enrollment, and disenrollment processes;
(5)
conducting eligibility determinations and redeterminations for premium subsidies and cost–sharing assistance;
(6)
providing referrals to appropriate agencies, including the Attorney General’s Health Education and Advocacy Unit and the Administration, for applicants and enrollees with grievances, complaints, questions, or the need for other social services;
(7)
providing all information and services in a manner that is culturally and linguistically appropriate and ensures accessibility for individuals with disabilities; and
(8)
providing ongoing support with respect to issues relating to eligibility, enrollment, renewal, and disenrollment in the Maryland Medical Assistance Program, the Maryland Children’s Health Program, and qualified plans offered in the Individual Exchange.
(d)
(1)
The consumer assistance services described in subsection (c) of this section that must be provided by an Individual Exchange navigator are those services that involve the sale, solicitation, and negotiation of qualified plans offered in the Individual Exchange, including:
(i)
examining or offering to examine a qualified plan for the purpose of giving, or offering to give, advice or information about the terms, conditions, benefits, coverage, or premium of a qualified plan;
(ii)
facilitating:
(1)
qualified plan selection;
(2)
the application of premium tax subsidies to selected qualified health plans;
(3)
plan application, enrollment, renewal, and disenrollment processes; and
(iii)
providing ongoing support with respect to issues relating to qualified plan enrollment, application of premium tax subsidies, renewal, and disenrollment.
(2)
The consumer assistance services described in subsection (c) of this section that do not have to be provided by an Individual Exchange navigator are:
(i)
conducting general education and outreach;
(ii)
facilitating eligibility determinations and redeterminations for premium tax subsidies, the Maryland Medical Assistance Program, and the Maryland Children’s Health Program; and
(iii)
facilitating and providing ongoing support with respect to the selection of managed care organizations, application processes, enrollment, and disenrollment for the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
(e)
(1)
The Exchange may authorize an Individual Exchange connector entity to provide consumer assistance services that:
(i)
are required to be provided by an Individual Exchange navigator; or
(ii)
subject to paragraph (2)(iii) of this subsection, result in a consumer’s enrollment in the Maryland Medical Assistance Program or the Maryland Children’s Health Program.
(2)
The Exchange:
(i)
may limit the authorization of an Individual Exchange connector entity to the provision of a subset of services, depending on the needs of the Individual Exchange navigator program and the capacity of the Individual Exchange connector entity, provided that the navigator program overall provides the totality of services required by the Affordable Care Act and this subtitle;
(ii)
pursuant to contractual agreement, may require an Individual Exchange connector entity to provide education, outreach, and other consumer assistance services in addition to the services provided under the Individual Exchange connector entity’s authorization in order to achieve all of the objectives of the navigator program; and
(iii)
may not authorize an Individual Exchange connector entity to provide services that result in a consumer’s enrollment in the Maryland Medical Assistance Program or the Maryland Children’s Health Program without the approval of the Maryland Department of Health.
(f)
An Individual Exchange connector entity:
(1)
shall obtain authorization from the Individual Exchange to provide services that:
(i)
are required to be provided by an Individual Exchange navigator; or
(ii)
result in a consumer’s enrollment in the Maryland Medical Assistance Program or the Maryland Children’s Health Program;
(2)
may provide:
(i)
those services that are within the scope of the Individual Exchange connector entity’s authorization; and
(ii)
any other consumer assistance services that:
(1)
are not required to be provided by an Individual Exchange navigator; or
(2)
do not require authorization under this subsection;
(3)
to the extent the scope of its authorization includes services that must be provided by an Individual Exchange navigator, shall provide those services only through Individual Exchange navigators;
(4)
in addition to the services it may provide under its authorization, may employ or engage other individuals to conduct:
(i)
consumer education and outreach; and
(ii)
determinations of eligibility for premium subsidies and cost–sharing assistance, the Maryland Medical Assistance Program, and the Maryland Children’s Health Program;
(5)
may employ or engage individuals to perform activities that:
(i)
are executive, administrative, managerial, or clerical; and
(ii)
relate only indirectly to services that must be provided by an Individual Exchange navigator or result in a consumer’s enrollment in the Maryland Medical Assistance Program or the Maryland Children’s Health Program;
(6)
shall comply with all State and federal laws, regulations, and policies governing the Maryland Medical Assistance Program and the Maryland Children’s Health Program;
(7)
may not receive any compensation, directly or indirectly:
(i)
from a carrier, an insurance producer, or a third–party administrator in connection with the enrollment of a qualified individual in a qualified health plan; or
(ii)
from any managed care organization that participates in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children’s Health Program; and
(8)
with respect to the insurance market outside the Exchange:
(i)
may not provide any information or services related to health benefit plans or other products not offered in the Exchange, except for general information about the insurance market outside the Exchange, which shall be limited to the information provided in a consumer education document developed by the Exchange and the Commissioner;
(ii)
shall refer any inquiries about health benefit plans or other products not offered in the Exchange to:
(1)
any resources that may be maintained by the Exchange; or
(2)
carriers and licensed insurance producers; and
(iii)
on contact with an individual who acknowledges having existing health insurance coverage obtained through an insurance producer, shall refer the individual back to the insurance producer for information and services unless:
(1)
the individual is eligible for but has not obtained a federal premium subsidy and cost–sharing assistance available only through the Individual Exchange;
(2)
the insurance producer is not authorized to sell qualified plans in the Individual Exchange; or
(3)
the individual would prefer not to seek further assistance from the individual’s insurance producer.
(g)
(1)
The Commissioner may suspend or revoke an Individual Exchange connector entity authorization after notice and opportunity for a hearing under §§ 2–210 through 2–214 of this article if the Individual Exchange connector entity:
(i)
has willfully violated this article or any regulation adopted under this article;
(ii)
has engaged in fraudulent or dishonest practices in conducting activities under the Individual Exchange connector entity authorization;
(iii)
has had any professional license or certification suspended or revoked for a fraudulent or dishonest practice;
(iv)
has been convicted of a felony, a crime of moral turpitude, or any criminal offense involving dishonesty or breach of trust; or
(v)
has willfully failed to comply with or violated a proper order or subpoena of the Commissioner.
(2)
Instead of or in addition to suspending or revoking an Individual Exchange connector entity authorization, the Commissioner may:
(i)
impose a penalty of not less than $100 but not exceeding $500 for each violation of this article; and
(ii)
require that restitution be made to any person who has suffered financial injury because of the Individual Exchange connector entity’s violation of this article.
(3)
The penalties available to the Commissioner under this subsection shall be in addition to any criminal or civil penalties imposed for fraud or other misconduct under any other State or federal law.
(4)
The Commissioner shall notify the Individual Exchange of any decision affecting the authorization of an Individual Exchange connector entity or any sanction imposed on an Individual Exchange connector entity under this subsection.
(5)
A carrier is not responsible for the activities and conduct of Individual Exchange connector entities.
(h)
An Individual Exchange navigator:
(1)
shall hold an Individual Exchange navigator certification issued under subsection (j) of this section;
(2)
may provide consumer assistance services that are required to be provided by an Individual Exchange navigator under subsection (d)(1) of this section;
(3)
may not be required to hold an insurance producer or adviser license;
(4)
shall be employed or engaged by an Individual Exchange connector entity or by the Exchange;
(5)
shall receive compensation only through the Individual Exchange or an Individual Exchange connector entity and not from a carrier or an insurance producer;
(6)
may not receive any compensation, directly or indirectly:
(i)
from a carrier, an insurance producer, or a third–party administrator in connection with the enrollment of a qualified individual in a qualified health plan; or
(ii)
from a managed care organization that participates in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children’s Health Program;
(7)
with respect to the insurance market outside the Exchange, is subject to the same requirements applicable to Individual Exchange connector entities as set forth in subsection (f)(8) of this section; and
(8)
shall comply with all State and federal laws, regulations, and policies governing the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
(i)
The Exchange:
(1)
shall establish and administer a process for Individual Exchange navigator certification and the issuance of Consolidated Services Center employee Individual Exchange enrollment permits;
(2)
in consultation with the Commissioner and the Maryland Department of Health, shall adopt regulations to implement this subsection; and
(3)
may implement the process for Individual Exchange navigator certification and the issuance of Consolidated Services Center employee Individual Exchange enrollment permits with the assistance of the Commissioner and the Maryland Department of Health, in accordance with one or more memoranda of understanding.
(j)
(1)
The Exchange shall issue an Individual Exchange navigator certification to each applicant who meets the requirements of this subsection.
(2)
To qualify for an Individual Exchange navigator certification, an applicant:
(i)
shall be of good character and trustworthy;
(ii)
shall be at least 18 years old;
(iii)
shall complete, and comply with any ongoing requirements of, the training program established under subsection (k) of this section; and
(iv)
shall comply with all applicable requirements of the Maryland Department of Health.
(3)
A certification shall expire 2 years after the date it is issued unless it is renewed.
(k)
(1)
The Exchange, with the approval of the Commissioner and in consultation with the Maryland Department of Health, the Health Education and Advocacy Unit of the Office of the Attorney General, and stakeholders, shall develop, implement, and, as appropriate, update a training program for the certification of Individual Exchange navigators and the issuance of Individual Exchange enrollment permits for Consolidated Services Center employees.
(2)
The training program shall:
(i)
provide Individual Exchange navigators and Consolidated Services Center employees with the full range of skills, knowledge, and expertise necessary to meet the consumer assistance, eligibility, enrollment, renewal, and disenrollment needs of individuals:
(1)
eligible for the Maryland Medical Assistance Program and the Maryland Children’s Health Program; or
(2)
seeking qualified plans offered in the Individual Exchange;
(ii)
enable the navigator program for the Individual Exchange and the Exchange’s Consolidated Services Center to provide robust protection of consumers and adherence to high quality assurance standards; and
(iii)
enable the Individual Exchange to ensure that, with respect to Individual Exchange navigators and Consolidated Services Center employees who offer any form of assistance to individuals regarding the Maryland Medical Assistance Program or the Maryland Children’s Health Program, the Individual Exchange navigator certification program and Consolidated Services Center shall comply with all requirements of the Maryland Department of Health.
(3)
The Individual Exchange, in consultation with the Maryland Department of Health and with the approval of the Commissioner, shall adopt regulations that govern:
(i)
the scope, type, conduct, frequency, and assessment of the training required for an Individual Exchange navigator certification;
(ii)
the experience requirements, if any, for an individual applicant to be eligible to participate in the training program; and
(iii)
the reinstatement of an expired Individual Exchange navigator certification or the reactivation of an inactive Individual Exchange navigator certification.
(l)
(1)
The Commissioner may suspend or revoke an Individual Exchange navigator certification after notice and opportunity for a hearing under §§ 2–210 through 2–214 of this article if the certified Individual Exchange navigator:
(i)
has willfully violated this article or any regulation adopted under this article;
(ii)
has intentionally misrepresented or concealed a material fact in the application for the Individual Exchange navigator certification;
(iii)
has obtained the Individual Exchange navigator certification by misrepresentation, concealment, or other fraud;
(iv)
has engaged in fraudulent or dishonest practices in conducting activities under the Individual Exchange navigator certification;
(v)
has misappropriated, converted, or unlawfully withheld money in conducting activities under the Individual Exchange navigator certification;
(vi)
has failed or refused to pay over on demand money that belongs to a person entitled to the money;
(vii)
has willfully and materially misrepresented the provisions of a qualified plan;
(viii)
has been convicted of a felony, a crime of moral turpitude, or any criminal offense involving dishonesty or breach of trust;
(ix)
has failed an examination required by this article or regulations adopted under this article;
(x)
has forged another’s name on an application for a qualified plan or on any other document in conducting activities under the Individual Exchange navigator certification;
(xi)
has otherwise shown a lack of trustworthiness or competence to act as an Individual Exchange navigator; or
(xii)
has willfully failed to comply with or violated a proper order or subpoena of the Commissioner.
(2)
Instead of or in addition to suspending or revoking a certification, the Commissioner may:
(i)
impose a penalty of not less than $100 but not exceeding $500 for each violation of this article; and
(ii)
require that restitution be made to any person who has suffered financial injury because of a violation of this article.
(3)
The penalties available to the Commissioner under this subsection shall be in addition to any criminal or civil penalties imposed for fraud or other misconduct under any other State or federal law.
(4)
The Commissioner shall notify the Individual Exchange and the Individual Exchange connector entity for which the Individual Exchange navigator works of any decision affecting the certification of an Individual Exchange navigator or any sanction imposed on an Individual Exchange navigator under this subsection.
(5)
A carrier is not responsible for the activities and conduct of Individual Exchange navigators.
(m)
(1)
The Exchange shall establish and administer an insurance producer authorization process for the Individual Exchange.
(2)
Under the process, the Exchange shall:
(i)
provide an authorization to sell qualified plans to a licensed insurance producer who meets the requirements in subsection (n) of this section; and
(ii)
require renewal of an authorization every 2 years.
(3)
(i)
Subject to the contested case hearing provisions of Title 10, Subtitle 2 of the State Government Article, the Exchange may suspend, revoke, or refuse to renew an authorization for good cause, which shall include a finding that the insurance producer holding the authorization has committed any act described in subsection (l)(1) of this section with respect to the authorization.
(ii)
The Individual Exchange shall notify the Commissioner of any decision affecting the status of an insurance producer’s authorization.
(4)
The Individual Exchange, with the approval of the Commissioner, shall adopt regulations to carry out this subsection.
(n)
(1)
Subject to the requirements in paragraph (2) of this subsection, an insurance producer who is licensed in the State and authorized by the Commissioner to sell, solicit, or negotiate health insurance may sell any qualified plan offered in the Individual Exchange without being separately certified as an Individual Exchange navigator.
(2)
To sell qualified plans in the Individual Exchange, an insurance producer shall:
(i)
register and apply for an authorization from the Exchange;
(ii)
complete and comply with any ongoing requirements of the training program established under subsection (o) of this section; and
(iii)
refer individuals seeking insurance who may be eligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program to the navigator program for the Individual Exchange.
(3)
An insurance producer:
(i)
may not be compensated by the Individual Exchange for the sale of a qualified plan offered in the Individual Exchange; and
(ii)
shall be compensated directly by a carrier.
(o)
(1)
The Exchange shall develop, implement, and, as appropriate, update a training program for insurance producers who sell qualified plans in the Individual Exchange.
(2)
The training program shall:
(i)
impart the skills and expertise necessary to perform functions specific to the Individual Exchange, such as making premium assistance eligibility determinations;
(ii)
enable the Exchange to provide robust protection of consumers and adherence to high quality assurance standards;
(iii)
impart the skills and expertise necessary to facilitate appropriate referrals of individuals and their dependents to the Maryland Medical Assistance Program, the Maryland Children’s Health Program, the appropriate Individual Exchange connector entity, an independent insurance producer, or the Consolidated Services Center; and
(iv)
be approved by the Commissioner.
(p)
(1)
Subject to paragraphs (2) through (7) of this subsection, until January 1, 2017, a captive producer, without being separately certified as an Individual Exchange navigator, may enroll, in a qualified plan offered in the Individual Exchange by the carrier from which the captive producer has an exclusive appointment:
(i)
an individual who:
(1)
is currently enrolled in one of the carrier’s nongroup plans; and
(2)
except as provided in paragraph (2) of this subsection, does not have an insurance producer of record in connection with the carrier’s nongroup plan; or
(ii)
an individual who:
(1)
initiates contact with the captive producer or the carrier for the purpose of requesting assistance or inquiring about the carrier’s plans; and
(2)
except as provided in paragraph (2) of this subsection, does not acknowledge having an insurance producer in connection with any existing insurance coverage.
(2)
(i)
If an individual under paragraph (1) of this subsection has an insurance producer, a captive producer shall refer the individual back to the insurance producer, together with any available contact information, for information and services, unless:
(1)
the individual is eligible for, but has not obtained a federal premium subsidy and cost–sharing assistance, and the insurance producer is not authorized to sell qualified plans in the Individual Exchange; or
(2)
the individual would prefer not to seek further assistance from the individual’s insurance producer.
(ii)
If a captive producer is not aware of an insurance producer of record, the captive producer shall disclose to an individual under paragraph (1) of this subsection that there may be an insurance producer of record in connection with an existing policy.
(3)
(i)
A carrier and its captive producers, in offering information and assistance to the carrier’s current enrollees regarding qualified plans offered in the Individual Exchange:
(1)
shall comply with fair marketing standards developed jointly by the Exchange and the Commissioner;
(2)
may not employ marketing practices or offer information and assistance only to certain enrollees in a manner that will have the effect of enrolling a disproportionate number of the carrier’s enrollees with significant health needs in qualified plans offered in the Individual Exchange; and
(3)
shall act in the best interest of the individual to whom the carrier and its captive producers provide assistance.
(ii)
A carrier shall provide to the Exchange, and update as needed, a list of its current captive producers.
(4)
Before providing an individual under paragraph (1) of this subsection any information or assistance with respect to qualified plans offered in the Individual Exchange, a captive producer in a manner prescribed under fair marketing standards established by the Commissioner and the Exchange, shall:
(i)
disclose to the individual that:
(1)
the captive producer is employed by the carrier and able to provide information about and sell only qualified plans offered by the carrier; and
(2)
the Individual Exchange offers other qualified plans, sold by other carriers, that may meet the individual’s needs;
(ii)
on the individual’s request:
(1)
refer the individual for further assistance to an independent insurance producer, the appropriate Individual Exchange connector entity, or the Consolidated Services Center; and
(2)
provide, through mail or electronic communication, written information about the Individual Exchange, the connector program, and the Consolidated Services Center; and
(iii)
document that the captive producer has provided the required disclosures and the individual has acknowledged that the individual:
(1)
understands the disclosures;
(2)
does not want to be referred to an independent insurance producer, an Individual Exchange connector entity, or the Consolidated Services Center; and
(3)
wants to receive information and assistance from the captive producer.
(5)
A record of the documentation required under paragraph (4)(iii) of this subsection shall be:
(i)
retained by a captive producer for at least 3 years;
(ii)
subject to the Commissioner’s review in a market conduct examination; and
(iii)
provided to the Exchange on a quarterly basis.
(6)
With respect to any health benefit plans or other products offered in the Individual Exchange or the insurance market outside the Individual Exchange by carriers other than the carrier with which the captive producer has an exclusive appointment, a captive producer:
(i)
may not provide any information or services related to health benefit plans or other products not offered by the captive producer’s carrier; and
(ii)
shall refer any inquiries about health benefit plans or other products not offered by the captive producer’s carrier to:
(1)
any resources that may be maintained by the Exchange; or
(2)
a licensed independent insurance producer.
(7)
If a carrier or a captive producer fails to comply with the requirements of this subsection, the Exchange may:
(i)
suspend, revoke, or refuse to renew the captive producer’s authorization under subsection (m)(3) of this section; and
(ii)
impose sanctions against the carrier under § 31–115(j) of this subtitle.
(q)
Nothing in this section shall prohibit a community–based organization or a unit of State or local government from providing the consumer assistance services described in subsection (c) of this section that are not required to be provided by an Individual Exchange navigator, if the entity providing the services and its employees do not:
(1)
receive any compensation, directly or indirectly, from a carrier, an insurance producer, or a third–party administrator in connection with the enrollment of a qualified individual in a qualified health plan;
(2)
receive any compensation, directly or indirectly, from a managed care organization that participates in the Maryland Medical Assistance Program or the Maryland Children’s Health Program; and
(3)
identify themselves to the public as Individual Exchange connector entities or Individual Exchange navigators.
(r)
(1)
To the extent and in the manner permitted or required by federal law or regulation governing application counselors and other Exchange consumer assistance personnel, subject to paragraph (2) of this subsection, and depending on its needs and resources, the Exchange may:
(i)
designate as an application counselor sponsoring entity under this subsection a community–based organization, health care provider, unit of State or local government, or other entity; and
(ii)
certify as an application counselor any agent, employee, or volunteer of an application counselor sponsoring entity who meets the requirements for Individual Exchange navigator certification under this section.
(2)
An application counselor sponsoring entity and an application counselor authorized to provide services under this subsection:
(i)
may not be compensated by the Exchange;
(ii)
may not impose a fee on individuals to whom they are authorized to provide services under this section for the services;
(iii)
shall disclose to the Exchange and to individuals to whom they provide services any relationships they have with:
(1)
a carrier, an insurance producer, or a third–party administrator; or
(2)
a managed care organization that participates in the Maryland Medical Assistance Program and the Maryland Children’s Health Program;
(iv)
shall act in the best interest of the individuals for whom they are authorized to provide services; and
(v)
may not be compensated by a carrier, insurance producer, or third–party administrator for their enrollment services.
(3)
An application counselor is subject to all requirements, restrictions, conflict of interest rules, and oversight applicable to:
(i)
Individual Exchange connector entities and Individual Exchange navigators under this subsection and any other relevant State or federal laws; and
(ii)
application counselors under federal law or regulation.
(4)
The Exchange, in consultation with the Commissioner and the Maryland Department of Health, may:
(i)
establish requirements for a sponsoring entity; and
(ii)
adopt regulations to carry out this subsection.
Md. Code Ann., Ins. § 31-113.1 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–113.1LinkCopy Citation
(a)
In accordance with the requirement to operate a toll–free hotline under § 1311(d)(4) of the Affordable Care Act and § 31–108(b)(5) of this subtitle, the Exchange may establish a Consolidated Services Center.
(b)
(1)
The CSC may employ individuals to assist the SHOP Exchange.
(2)
A CSC employee authorized to assist the SHOP Exchange:
(i)
may provide the services set forth in § 31–112(c)(1) of this subtitle, but may not initiate contact with a small employer for the purpose of soliciting the small employer to provide qualified plans offered by the SHOP Exchange to its employees;
(ii)
shall hold a SHOP Exchange enrollment permit;
(iii)
is not a SHOP Exchange navigator and may not hold a SHOP Exchange navigator license;
(iv)
may not be required to hold an insurance producer license; and
(v)
shall comply with the limitations set forth in § 31–112(c)(3) of this subtitle.
(3)
(i)
The Commissioner shall issue a SHOP Exchange enrollment permit to each applicant who meets the requirements of this paragraph.
(ii)
To qualify for a SHOP Exchange enrollment permit, an applicant:
(1)
shall be of good character and trustworthy;
(2)
shall be at least 18 years old;
(3)
shall pass the written examination given by the Commissioner to applicants for a SHOP navigator license under § 31–112(d)(2)(iii) of this subtitle;
(4)
shall be engaged by, and receive compensation only through, the CSC;
(5)
may not receive compensation from or otherwise be affiliated with a carrier, an insurance producer, a third–party administrator, or any other person connected to the insurance industry; and
(6)
shall complete, and comply with any ongoing requirements of, the training program established under § 31–112(h) of this subtitle.
(4)
The Commissioner’s duties and authority under § 31–112(d)(3) and (e) of this subtitle shall apply to CSC employees who hold a SHOP Exchange enrollment permit issued under this subsection.
(c)
(1)
The CSC may employ individuals to assist the Individual Exchange.
(2)
A CSC employee authorized to assist the Individual Exchange:
(i)
may provide the services set forth in § 31–113(d) of this subtitle, but may not initiate contact with an individual for the purpose of soliciting the individual to enroll in a qualified plan offered by the Individual Exchange;
(ii)
shall hold an Individual Exchange enrollment permit;
(iii)
is not an Individual Exchange navigator and may not hold an Individual Exchange navigator certification;
(iv)
may not be required to hold an insurance producer or adviser license;
(v)
with respect to the insurance market outside the Exchange, shall comply with § 31–113(f)(8) of this subtitle;
(vi)
shall inquire whether an individual has health insurance obtained through an insurance producer and, if so, shall refer the individual to the insurance producer for information and services unless:
(1)
the individual is eligible for, but has not obtained a federal premium subsidy and cost–sharing assistance, and the insurance producer is not authorized to sell qualified plans in the Individual Exchange; or
(2)
the individual would prefer not to seek further assistance from the individual’s insurance producer; and
(vii)
shall comply with all State and federal laws, regulations, and policies governing the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
(3)
(i)
The Exchange shall issue an Individual Exchange enrollment permit to each applicant who meets the requirements of this paragraph.
(ii)
To qualify for an Individual Exchange enrollment permit, an applicant:
(1)
shall be of good character and trustworthy;
(2)
shall be at least 18 years old;
(3)
shall be engaged by, and receive compensation only through, the CSC;
(4)
may not receive any compensation, directly or indirectly, from:
(A)
a carrier, an insurance producer, or a third–party administrator in connection with the enrollment of a qualified individual in a qualified health plan; or
(B)
a managed care organization that participates in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children’s Health Program; and
(5)
shall complete, and comply with any ongoing requirements of, the training program established under § 31–113(k) of this subtitle.
(4)
The Commissioner’s duties and authority under § 31–113(l) of this subtitle shall apply to CSC employees who hold an Individual Exchange enrollment permit issued under this subsection.
(d)
The Exchange, the CSC, and CSC employees shall assist the Health Education and Advocacy Unit of the Office of the Attorney General in carrying out its duties to assist consumers under Title 13, Subtitle 4A of the Commercial Law Article and Title 15, Subtitles 10A and 10D of this article.
Md. Code Ann., Ins. § 31-114 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–114LinkCopy Citation
(a)
Nothing in this subtitle requires the Maryland Medical Assistance Program or the Maryland Children’s Health Program to provide any specific financial support to the Individual Exchange for the services provided by an Individual Exchange navigator or an Individual Exchange connector entity.
(b)
The financing arrangements between the Individual Exchange, the Maryland Medical Assistance Program, and the Maryland Children’s Health Program shall be governed by a memorandum of agreement between the Exchange and the Maryland Department of Health.
Md. Code Ann., Ins. § 31-115 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–115LinkCopy Citation
(a)
The Exchange shall certify:
(1)
health benefit plans as qualified health plans;
(2)
dental plans as qualified dental plans, which may be offered by carriers as:
(i)
stand–alone dental plans; or
(ii)
dental plans sold in conjunction with or as an endorsement to qualified health plans;
(3)
vision plans as qualified vision plans, which may be offered by carriers as:
(i)
stand–alone vision plans; or
(ii)
vision plans sold in conjunction with or as an endorsement to qualified health plans; and
(4)
stand–alone dental plans for sale outside the Exchange.
(b)
To be certified as a qualified health plan, a health benefit plan shall:
(1)
provide the essential health benefits required under § 1302(a) of the Affordable Care Act and § 31–116 of this subtitle;
(2)
obtain prior approval of premium rates and contract language from the Commissioner;
(3)
except as provided in subsection (d) of this section, provide at least a bronze level of coverage, as defined in the Affordable Care Act and determined by the Exchange under § 31–108(b)(8)(ii) of this subtitle;
(4)
(i)
ensure that its cost–sharing requirements do not exceed the limits established under § 1302(c)(1) of the Affordable Care Act; and
(ii)
if the health benefit plan is offered through the SHOP Exchange, ensure that the health benefit plan’s deductible does not exceed the limits established under § 1302(c)(2) of the Affordable Care Act;
(5)
be offered by a carrier that:
(i)
is licensed and in good standing to offer health insurance coverage in the State;
(ii)
offers in each Exchange, the Individual and the SHOP, in which the carrier participates, at least one qualified health plan:
(1)
at a bronze level of coverage;
(2)
at a silver level of coverage; and
(3)
at a gold level of coverage;
(iii)
if the carrier participates in the Individual Exchange and offers any health benefit plan in the individual market outside the Exchange, offers at least one qualified health plan at the silver level and one at the gold level in the individual market outside the Exchange;
(iv)
if the carrier participates in the SHOP Exchange and offers any health benefit plan in the small group market outside the SHOP Exchange, offers at least one qualified health plan at the silver level and one at the gold level in the small group market outside the SHOP Exchange;
(v)
charges the same premium rate for each qualified health plan regardless of whether the qualified health plan is offered through the Exchange, through an insurance producer outside the Exchange, or directly from a carrier;
(vi)
does not charge any cancellation fees or penalties in violation of § 31–108(d) of this subtitle; and
(vii)
complies with the regulations adopted by the Secretary under § 1311(d) of the Affordable Care Act and by the Exchange under § 31–106(c)(1)(iv) of this subtitle;
(6)
meet the requirements for certification established under the regulations adopted by:
(i)
the Secretary under § 1311(c)(1) of the Affordable Care Act, including minimum standards for marketing practices, network adequacy, essential community providers in underserved areas, accreditation, quality improvement, uniform enrollment forms and descriptions of coverage, and information on quality measures for health plan performance; and
(ii)
the Exchange under § 31–106(c)(1)(iv) of this subtitle;
(7)
be in the interest of qualified individuals, qualified residents, and qualified employers, as determined by the Exchange;
(8)
provide any other benefits as may be required by the Commissioner under any applicable State law or regulation; and
(9)
meet any other requirements established by the Exchange under this subtitle, including:
(i)
transition of care language in contracts as determined appropriate by the Exchange to ensure care continuity and reduce duplication and costs of care;
(ii)
criteria that encourage and support qualified plans in facilitating cross–border enrollment; and
(iii)
demonstrating compliance with the federal Mental Health Parity and Addiction Equity Act of 2008.
(c)
The Exchange may determine whether a carrier may elect to offer coverage for nonessential vision benefits in either the SHOP Exchange or Individual Exchange.
(d)
A qualified health plan is not required to provide at least a bronze level of coverage under subsection (b)(3) of this section if the qualified health plan:
(1)
meets the requirements and is certified as a qualified catastrophic plan as provided under the Affordable Care Act; and
(2)
will be offered only to individuals eligible for catastrophic coverage.
(e)
A health benefit plan may not be denied certification:
(1)
solely on the grounds that the health benefit plan is a fee–for–service plan;
(2)
through the imposition of premium price controls by the Exchange; or
(3)
solely on the grounds that the health benefit plan provides treatments necessary to prevent patients’ deaths in circumstances the Exchange determines are inappropriate or too costly.
(f)
In addition to other rate filing requirements that may be applicable under this article, each carrier seeking certification of a health benefit plan shall:
(1)
(i)
submit to the Exchange notice of any premium increase before implementation of the increase; and
(ii)
post the increase on the carrier’s website;
(2)
submit to the Exchange, the Secretary, and the Commissioner, and make available to the public, in plain language as required under § 1311(e)(3)(b) of the Affordable Care Act, accurate and timely disclosure of:
(i)
claims payment policies and practices;
(ii)
financial disclosures;
(iii)
data on enrollment, disenrollment, number of claims denied, and rating practices;
(iv)
information on cost–sharing and payments with respect to out–of–network coverage;
(v)
information on enrollee and participant rights under Title I of the Affordable Care Act; and
(vi)
any other information as determined appropriate by the Secretary and the Exchange; and
(3)
make available information about costs an individual would incur under the individual’s health benefit plan for services provided by a participating health care provider, including cost–sharing requirements such as deductibles, co–payments, and coinsurance, in a manner determined by the Exchange.
(g)
(1)
Except as provided in paragraphs (2) through (5) of this subsection, the requirements applicable to qualified health plans under this subtitle also shall apply to qualified dental plans to the extent relevant, whether offered in conjunction with or as an endorsement to qualified health plans or as stand–alone dental plans.
(2)
A carrier offering a qualified dental plan shall be licensed to offer dental coverage but need not be licensed to offer other health benefits.
(3)
A qualified dental plan shall:
(i)
be limited to dental and oral health benefits, without substantial duplication of other benefits typically offered by health benefit plans without dental coverage; and
(ii)
include at a minimum:
(1)
the essential pediatric dental benefits required by the Secretary under § 1302(b)(1)(j) of the Affordable Care Act; and
(2)
other dental benefits required by the Secretary or the Exchange.
(4)
(i)
The Exchange may determine:
(1)
the manner in which carriers must disclose the price of oral and dental benefits and, to the extent relevant, medical benefits, when offered:
(A)
to the extent permitted by the Exchange, in a qualified health plan;
(B)
in conjunction with or as an endorsement to a qualified health plan; or
(C)
as a stand–alone plan; and
(2)
when a carrier offers a qualified dental plan in conjunction with a qualified health plan, whether the carrier also must make the qualified health plan, the qualified dental plan, or both qualified plans available on a stand–alone basis.
(ii)
In determining the manner in which carriers must offer and disclose the price of medical, oral, and dental benefits under this paragraph, the Exchange shall balance the objectives of transparency and affordability for consumers.
(5)
The Exchange may:
(i)
exempt qualified dental plans from a requirement applicable to qualified health plans under this subtitle to the extent the Exchange determines the requirement is not relevant to qualified dental plans; and
(ii)
establish additional requirements for qualified dental plans in conjunction with its establishment of additional requirements for qualified health plans under subsection (b)(9) of this section.
(h)
(1)
Except as provided in paragraphs (2) through (5) of this subsection, the requirements applicable to qualified health plans under this subtitle also shall apply to qualified vision plans to the extent relevant, whether offered in conjunction with or as an endorsement to qualified health plans or as stand–alone vision plans.
(2)
A carrier offering a qualified vision plan shall be licensed to offer vision coverage but need not be licensed to offer other health benefits.
(3)
A qualified vision plan shall:
(i)
be limited to vision and eye health benefits, without substantial duplication of other benefits typically offered by health benefit plans without vision coverage; and
(ii)
include at a minimum:
(1)
the essential pediatric vision benefits required by the Secretary under § 1302(b)(1)(j) of the Affordable Care Act; or
(2)
other vision benefits required by the Secretary or the Exchange.
(4)
(i)
The Exchange may determine:
(1)
the manner in which carriers must disclose the price of vision benefits and, to the extent relevant, medical benefits, when offered:
(A)
to the extent permitted by the Exchange, in a qualified health plan;
(B)
in conjunction with or as an endorsement to a qualified health plan; or
(C)
as a stand–alone plan; and
(2)
when a carrier offers a qualified vision plan in conjunction with a qualified health plan, whether the carrier also must make the qualified health plan, the qualified vision plan, or both qualified plans available on a stand–alone basis.
(ii)
In determining the manner in which carriers must offer and disclose the price of medical and vision benefits under this paragraph, the Exchange shall balance the objectives of transparency and affordability for consumers.
(5)
The Exchange may:
(i)
exempt qualified vision plans from a requirement applicable to qualified health plans under this subtitle to the extent the Exchange determines the requirement is not relevant to qualified vision plans; and
(ii)
establish additional requirements for qualified vision plans in conjunction with its establishment of additional requirements for qualified health plans under subsection (b)(9) of this section.
(i)
A managed care organization may not be required to offer a qualified plan in the Exchange.
(j)
(1)
Subject to the contested case hearing provisions of Title 10, Subtitle 2 of the State Government Article, and subsection (e) of this section, and except as provided in subsection (k)(2) of this section, the Exchange may deny certification to a health benefit plan, a dental plan, or a vision plan, or suspend or revoke the certification of a qualified plan, based on a finding that the health benefit plan, dental plan, vision plan, or qualified plan does not satisfy requirements or has otherwise violated standards for certification that are:
(i)
established under the regulations and interim policies adopted by the Exchange to carry out this subtitle; and
(ii)
not otherwise under the regulatory and enforcement authority of the Commissioner.
(2)
Certification requirements shall include providing data and meeting standards related to:
(i)
enrollment;
(ii)
essential community providers;
(iii)
complaints and grievances involving the Exchange;
(iv)
network adequacy;
(v)
quality;
(vi)
transparency;
(vii)
race, ethnicity, language, interpreter need, and cultural competency (RELICC);
(viii)
plan service area, including demographics;
(ix)
accreditation; and
(x)
complying with fair marketing standards developed jointly by the Exchange and the Commissioner.
(3)
Instead of or in addition to denying, suspending, or revoking certification, the Exchange may impose other remedies or take other actions, including:
(i)
taking corrective action to remedy a violation of or failure to comply with standards for certification; and
(ii)
imposing a penalty not exceeding $5,000 for each violation of or failure to comply with standards for certification.
(4)
In determining the amount of a penalty under paragraph (3)(ii) of this subsection, the Exchange shall consider:
(i)
the type, severity, and duration of the violation;
(ii)
whether the plan or carrier knew or should have known of the violation;
(iii)
the extent to which the plan or carrier has a history of violations; and
(iv)
whether the plan or carrier corrected the violation as soon as they knew or should have known of the violation.
(5)
The penalties available to the Exchange under this subsection shall be in addition to any criminal or civil penalties imposed for fraud or other violation under any other State or federal law.
(6)
(i)
A carrier or plan, under Title 10, Subtitle 2 of the State Government Article and the Exchange’s appeals and grievance process may:
(1)
appeal an order or decision issued by the Exchange under this section; and
(2)
request a hearing.
(ii)
A demand for a hearing stays a decision or order of the Exchange pending the hearing, and a final order of the Exchange resulting from it, if the Exchange receives the demand:
(1)
before the effective date of the order; or
(2)
within 10 days after the order is served.
(iii)
If a petition for judicial review is filed with the appropriate court under Title 10, Subtitle 2 of the State Government Article, the court has jurisdiction over the case and shall determine whether the filing operates as a stay of the order from which the appeal is taken.
(k)
(1)
To be certified for sale outside the Exchange, a stand–alone dental plan shall be reviewed and approved by the Administration as meeting appropriate requirements, including:
(i)
covering the State benchmark pediatric dental essential health benefits;
(ii)
complying with annual limits and lifetime limits applicable to essential health benefits;
(iii)
complying with annual limits on cost sharing applicable to stand–alone dental plans under 45 C.F.R. § 156.150; and
(iv)
meeting the same actuarial value requirement for the pediatric dental essential health benefits that is required for a qualified dental plan.
(2)
Subject to the contested case hearing provisions of Title 10, Subtitle 2 of the State Government Article, the Exchange may deny, suspend, or revoke the certification of a stand–alone dental plan for sale outside the Exchange if the stand–alone dental plan does not satisfy the requirements of paragraph (1) of this subsection.
(l)
Any certification standards established under subsection (j) of this section related to network adequacy or network directory accuracy:
(1)
shall be consistent with the provisions of § 15–112 of this article; and
(2)
may not be implemented until January 1, 2019.
Md. Code Ann., Ins. § 31-116 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–116LinkCopy Citation
(a)
The essential health benefits required under § 1302(a) of the Affordable Care Act:
(1)
shall be the benefits in the State benchmark plan, selected in accordance with this section; and
(2)
notwithstanding any other benefits mandated by State law, shall be the benefits required in:
(i)
subject to subsection (f) of this section, all individual health benefit plans and health benefit plans offered to small employers, except for grandfathered health plans, as defined in the Affordable Care Act, offered outside the Exchange; and
(ii)
all qualified health plans offered in the Exchange.
(b)
In selecting the State benchmark plan, the State seeks to:
(1)
balance comprehensiveness of benefits with plan affordability to promote optimal access to care for all residents of the State;
(2)
accommodate to the extent practicable the diverse health needs across the diverse populations within the State; and
(3)
ensure the benefit of input from the stakeholders and the public.
(c)
(1)
The State benchmark plan, for 2017 and until the Secretary requires that a new benchmark plan be selected, shall be selected by the Commissioner, in consultation with the Exchange:
(i)
based on enrollment for the first quarter of 2014, from the largest health plan by enrollment in any of the three largest small group insurance products by enrollment in the State’s small group market; and
(ii)
through an open, transparent, and inclusive process, which shall include at least one public hearing and an opportunity for public comment.
(2)
In selecting the State benchmark plan, the Commissioner, in consultation with the Exchange, may exclude, consistent with applicable federal regulations:
(i)
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
(ii)
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.
(d)
In selecting the State benchmark plan, the Commissioner, in consultation with the Exchange, shall:
(1)
select a plan that complies with all requirements of this subtitle and the Affordable Care Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and any other federal laws, regulations, policies, or guidance applicable to state benchmark plans and essential health benefits;
(2)
for individual health benefit plans, require that the health benefit plans include any mandated benefits that were required in individual health benefit plans before December 31, 2011, if the benefits are not included in the selected benchmark plan; and
(3)
if the selected state benchmark plan does not comply with any federal benefit requirement, supplement the required benefits, to the extent permitted by federal law, with benefits similar to those chosen by the Maryland Health Care Reform Coordinating Council in 2012.
(e)
Within 10 days after selecting the State benchmark plan, the Commissioner shall submit a report, in accordance with § 2–1257 of the State Government Article, to the Senate Finance Committee and the House Health and Government Operations Committee advising the Committees of the Commissioner’s selection and the process used in making the selection.
(f)
(1)
(i)
In this subsection the following words have the meanings indicated.
(ii)
“Exchange certified stand–alone dental plan” means a stand–alone dental plan that has been certified by the Exchange for sale outside the Exchange under § 31–115 of this subtitle.
(iii)
“Purchaser” means:
(1)
with respect to an individual health benefit plan, the individual applying for coverage; and
(2)
with respect to a small group health benefit plan, the employer applying for coverage.
(2)
To the extent permitted under federal law, a health benefit plan offered outside the Exchange to individuals or small employers is not required to provide pediatric dental essential health benefits if:
(i)
at the time the carrier offers the health benefit plan, the carrier discloses in a form approved by the Commissioner that the health benefit plan does not provide the full range of pediatric dental essential health benefits; and
(ii)
the carrier is reasonably assured that the enrollee has obtained full coverage of pediatric dental essential health benefits through an Exchange certified stand–alone dental plan.
(3)
A carrier shall:
(i)
disclose to a potential purchaser, for those health benefit plans sold outside the Exchange that do not provide the pediatric dental essential health benefits, that the plan does not include the pediatric dental essential health benefits; and
(ii)
for those health benefit plans sold outside the Exchange that do not provide the pediatric dental essential health benefits, include on its application completed by a purchaser the following:
“Have you obtained stand–alone dental coverage that provides pediatric dental essential health benefits through a Maryland Health Benefit Exchange certified stand–alone dental plan offered outside the Maryland Health Benefit Exchange?
Yes ____ No ____
If you answered “Yes”, please provide the name of the company issuing the stand–alone dental coverage.
If you answered “No”, you will be issued a health benefit plan that includes the pediatric dental essential health benefits.”
(4)
The Administration shall place on its website a list of the Exchange certified stand–alone dental plans in the State.
Md. Code Ann., Ins. § 31-117 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–117LinkCopy Citation
(a)
The Exchange, in consultation with the Commissioner and as approved by the Board, shall establish and implement a State Reinsurance Program:
(1)
to provide reinsurance to carriers that offer individual health benefit plans in the State;
(2)
that meets the requirements of a waiver approved under § 1332 of the Affordable Care Act; and
(3)
that is consistent with State and federal law.
(b)
The State Reinsurance Program shall be designed to mitigate the impact of high–risk individuals on rates in the individual insurance market inside and outside the Exchange.
(c)
(1)
Based on available funds, the Exchange, in consultation with the Commissioner and as approved by the Board, shall establish reinsurance payment parameters for calendar year 2019 and each subsequent calendar year that include:
(i)
an attachment point;
(ii)
a coinsurance rate; and
(iii)
a coinsurance cap.
(2)
The Exchange, in consultation with the Commissioner and as approved by the Board, may alter the parameters established in accordance with paragraph (1) of this subsection as necessary to secure federal approval for a waiver submitted in accordance with § 31–117.1(a) of this subtitle.
(d)
Beginning January 1, 2019, funding for reinsurance in the individual market through the State Reinsurance Program may be made by using:
(1)
any pass–through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act;
(2)
any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; and
(3)
any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State.
(e)
The implementation of a State Reinsurance Program for reinsurance in the individual market shall be contingent on approval from the U.S. Secretary of Health and Human Services and the U.S. Secretary of the Treasury of a State Innovation Waiver application under § 1332 of the Affordable Care Act.
(f)
On or before January 1, 2019, the Exchange shall adopt regulations implementing the provisions of this section.
Md. Code Ann., Ins. § 31-117.1 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–117.1LinkCopy Citation
(a)
As soon as practicable but not later than July 1, 2018, the Exchange, in consultation with the Commissioner and as approved by the Board, shall submit a State Innovation Waiver application under § 1332 of the Affordable Care Act to establish a program for reinsurance and seek federal pass–through funding.
(b)
On or before December 31, 2018, the Commissioner may waive any notification or other requirements that apply to a carrier under this article in calendar year 2018 due to the implementation of a waiver approved under § 1332 of the Affordable Care Act.
Md. Code Ann., Ins. § 31-118 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–118LinkCopy Citation
(a)
Beginning January 1, 2014, subject to subsections (b) and (c) of this section, the Exchange may:
(1)
impose user fees, licensing or other regulatory fees, or other assessments that do not exceed reasonable projections regarding the amount necessary to support the operations of the Exchange under this subtitle; or
(2)
otherwise generate funding necessary to support its operations under this subtitle.
(b)
Any fees, assessments, or other funding mechanisms shall be imposed or implemented, to the maximum extent possible, in a manner that is transparent and broad–based.
(c)
Before imposing or altering any fee or assessment established by law, the Exchange shall adopt regulations that specify:
(1)
the persons subject to the fee or assessment;
(2)
the amount of the fee or assessment; and
(3)
the manner in which the fee or assessment will be collected.
(d)
Funds collected through any fees, assessments, or other funding mechanisms:
(1)
shall be deposited in the Fund;
(2)
shall be used only for the purposes authorized under this subtitle; and
(3)
may not be used for staff retreats, promotional giveaways, excessive executive compensation, or promotion of federal or State legislative and regulatory actions.
(e)
The Exchange may not impose fees or assessments authorized under this section in a manner that would provide a competitive disadvantage to health benefit plans operating outside of the Exchange.
(f)
The Exchange shall maintain a website on which it shall publish:
(1)
the average amounts of any fees, assessments, or other payments required by the Exchange;
(2)
the administrative costs of the Exchange; and
(3)
the amount of funds known to be lost through waste, fraud, and abuse.
Md. Code Ann., Ins. § 31-119 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–119LinkCopy Citation
(a)
The Exchange shall be administered in a manner designed to:
(1)
prevent discrimination on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation;
(2)
streamline enrollment and other processes to minimize expenses and achieve maximum efficiency;
(3)
prevent waste, fraud, and abuse; and
(4)
promote financial integrity.
(b)
(1)
The Exchange shall establish a full–scale fraud, waste, and abuse detection and prevention program designed to:
(i)
ensure the Exchange’s compliance with federal and State laws for the detection and prevention of fraud, waste, and abuse, including whistleblower and confidentiality protections and federal anti–kickback prohibitions; and
(ii)
promote transparency, credibility, and trust on the part of the public in the integrity of its operations.
(2)
The fraud, waste, and abuse detection and prevention program shall:
(i)
establish a framework for internal controls;
(ii)
identify control cycles;
(iii)
conduct risk assessments;
(iv)
document processes; and
(v)
implement controls.
(3)
The Exchange:
(i)
shall, in accordance with § 2–1257 of the State Government Article, submit its plan for the fraud, waste, and abuse detection and prevention program to the Senate Finance Committee and the House Health and Government Operations Committee; and
(ii)
shall allow the committees 60 days for review and comment before establishing the program.
(c)
The Exchange shall keep an accurate accounting of all its activities, expenditures, and receipts.
(d)
(1)
On or before December 1 of each year, the Board shall forward to the Secretary, the Governor, and, in accordance with § 2–1257 of the State Government Article, the General Assembly, a report on the activities, expenditures, and receipts of the Exchange.
(2)
The report shall:
(i)
be in the standardized format required by the Secretary;
(ii)
include data regarding:
(1)
health plan participation, ratings, coverage, price, quality improvement measures, and benefits;
(2)
consumer choice, participation, and satisfaction information to the extent the information is available;
(3)
financial integrity, fee assessments, and status of the Fund; and
(4)
any other appropriate metrics related to the operation of the Exchange that may be used to evaluate Exchange performance, assure transparency, and facilitate research and analysis;
(iii)
assess and, to the extent feasible and permitted by law, include data to identify disparities related to gender, race, ethnicity, geographic location, language, disability, gender identity, sexual orientation, or other attributes of special populations; and
(iv)
include information on its fraud, waste, and abuse detection and prevention program.
(e)
(1)
The Board shall cooperate fully with any investigation into the affairs of the Exchange, including making available for examination the records of the Exchange, conducted by:
(i)
the Secretary under the Secretary’s authority under the Affordable Care Act; and
(ii)
the Commissioner under the Commissioner’s authority under this article.
(2)
The Commissioner may adopt regulations establishing the minimum length of time for which, and the manner in which, the Exchange is required to maintain records of insurance transactions conducted by the Exchange.
Md. Code Ann., Ins. § 31-120 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–120LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Central Repository” means the Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.
(3)
“Contractor” means an individual who:
(i)
is not a State employee with a position in the State Personnel Management System; and
(ii)
performs work functions for the Exchange in accordance with the terms of a written agreement.
(b)
The purpose of this section is to authorize the Exchange to perform a criminal background check, including a State and national criminal history records check, to determine the suitability of a contractor to access confidential or sensitive federal tax information in accordance with federal laws and regulations.
(c)
For any contractor who has or may obtain access to federal tax information that is considered confidential or sensitive under federal or State law or regulation, the Exchange may:
(1)
require the contractor to provide information necessary to perform a criminal background check including, for at least the immediately preceding 5–year period, the contractor’s:
(i)
address history; and
(ii)
employment and education history, including the names and addresses of all previous employers and schools attended;
(2)
request a State and national criminal history records check on the contractor from the Central Repository;
(3)
as part of the application for a criminal history records check, collect from the contractor and submit to the Central Repository:
(i)
two complete sets of the contractor’s legible fingerprints taken in a format approved by the Director of the Central Repository and the Director of the Federal Bureau of Investigation;
(ii)
the fee authorized under § 10–221(b)(7) of the Criminal Procedure Article for access to Maryland criminal history records;
(iii)
the mandatory processing fee required by the Federal Bureau of Investigation for a national criminal history records check; and
(iv)
any other documents or fees required by the Central Repository for completion of a criminal history records check; and
(4)
conduct a reinvestigation within 10 years after the date of the previous background investigation for each contractor with access to federal tax information.
(d)
In accordance with §§ 10–201 through 10–229 of the Criminal Procedure Article, the Central Repository shall forward to the contractor and the Exchange the contractor’s criminal history record information.
(e)
Information obtained from the Central Repository under this section:
(1)
is confidential;
(2)
may not be redisseminated except as allowed by federal or State law or regulation; and
(3)
may be used only for the purposes authorized under this section.
(f)
A contractor who is the subject of a criminal history records check under this section may contest the criminal history record information issued by the Central Repository as provided in § 10–223 of the Criminal Procedure Article.
(g)
If criminal history record information is reported to the Central Repository after the date of the initial criminal history records check, the Central Repository shall provide to the Exchange and the contractor revised criminal history record information on the contractor.
(h)
A contractor who refuses to comply with or fails the criminal history records check under this section may not perform work functions for the Exchange that require access to federal tax information.
(i)
The Board may adopt regulations, guidelines, and policies to carry out this section.
(j)
This section does not limit the authority of the Exchange to perform a background investigation or request a criminal history records check for personnel in accordance with §§ 7–103 and 7–104 of the State Personnel and Pensions Article.
Md. Code Ann., Ins. § 31-121 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–121LinkCopy Citation
(a)
The Exchange, in consultation with the Commissioner and as approved by the Board, may submit a State Innovation Waiver application under § 1332 of the Affordable Care Act to allow the State to administer the federal Small Business Health Care Tax Credit to small businesses for monthly premium payments.
(b)
Before applying for a State Innovation Waiver under subsection (a) of this section, the Exchange shall determine whether the State needs to apply for a State Innovation Waiver in order to distribute the federal Small Business Health Care Tax Credit on a monthly basis to eligible employers enrolling in the SHOP Exchange.
Md. Code Ann., Ins. § 31-122 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–122LinkCopy Citation
(a)
In this section, “Program” means the State–Based Young Adult Health Insurance Subsidies Program.
(b)
(1)
Subject to paragraph (2) of this subsection, the Exchange, in consultation with the Commissioner and as approved by the Board, may establish and implement a State–Based Young Adult Health Insurance Subsidies Program to provide subsidies to young adults for the purchase of health benefit plans in the individual health insurance market.
(2)
The Exchange may not implement the Program for calendar years in which funds from the distribution of the assessment under § 6–102.1 of this article are not available.
(c)
The Program required under this section shall be designed to:
(1)
reduce the amount that young adults pay for health benefit plans in the individual health insurance market; and
(2)
target young adults who are not directly impacted by the State Reinsurance Program.
(d)
(1)
For each calendar year, the Exchange, in consultation with the Commissioner and as approved by the Board, shall establish subsidy eligibility and payment parameters for the Program.
(2)
In determining the subsidy eligibility and payment parameters required under paragraph (1) of this subsection, the Exchange shall consider:
(i)
young adults at least 18 years old and under the age of 41 years; and
(ii)
income groups between 133% and 400% of the federal poverty level.
(e)
(1)
Subject to available funds and paragraph (2) of this subsection, in each fiscal year, the Exchange may designate funds from the Fund to be used for the Program so that annual subsidies may be provided to young adults who meet the subsidy eligibility and payment parameters established under subsection (d) of this section.
(2)
(i)
For each of calendar years 2024 and 2025, the funds designated under paragraph (1) of this subsection may not exceed $20,000,000 plus any unspent funds designated for subsidies for young adults in a previous calendar year.
(ii)
For calendar year 2026 and each calendar year thereafter, the Exchange, in consultation with the Commissioner, may designate funds from the Fund to provide annual subsidies to young adults who meet the subsidy eligibility and payment parameters established under subsection (d) of this section.
(f)
The Exchange shall adopt regulations implementing the provisions of this section.
(g)
The Exchange shall adopt regulations to provide a subsidy to cover 100% of the cost of the premium for young adults who have a 0% expected contribution under the subsidy eligibility parameters established under subsection (d) of this section.
(h)
(1)
The Exchange shall track on a monthly basis expenditures on subsidies provided under the Program, including:
(i)
the average number of young adults receiving subsidies under the Program; and
(ii)
the average subsidy amount received by young adults under the Program.
(2)
The Exchange shall track:
(i)
the impact the Program has on rates in the individual insurance market; and
(ii)
the impact of covering 100% of the cost of premiums for qualified participants on effectuation rates and termination for nonpayment rates.
(3)
The information tracked by the Exchange under paragraphs (1) and (2) of this subsection shall be:
(i)
posted on the website of the Exchange; and
(ii)
included in the annual report required under § 31–119(d) of this subtitle.
Md. Code Ann., Ins. § 31-123 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–123LinkCopy Citation
(a)
On or before July 1, 2025, the Exchange, in consultation with the Commissioner and as approved by the Board, shall submit a State Innovation Waiver application amendment under § 1332 of the Affordable Care Act to establish a Qualified Resident Enrollment Program and, if available, seek federal pass–through funding resulting from the implementation of a Qualified Resident Enrollment Program.
(b)
On or before December 31, 2025, the Commissioner may waive any notification or other requirements that apply to a carrier under this article in calendar year 2025 due to the implementation of a waiver approved under § 1332 of the Affordable Care Act.
Md. Code Ann., Ins. § 31-124 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–124LinkCopy Citation
(a)
The Exchange, in consultation with the Commissioner and as approved by the Board, shall establish and implement a Qualified Resident Enrollment Program:
(1)
to facilitate the enrollment of qualified residents in qualified plans;
(2)
that, as necessary, meets the requirements of a waiver approved under § 1332 of the Affordable Care Act; and
(3)
that is consistent with federal and State law.
(b)
The Qualified Resident Enrollment Program shall allow qualified residents to purchase qualified plans on the Individual Exchange.
(c)
(1)
The implementation of the Qualified Resident Enrollment Program shall be contingent on approval from the U.S. Secretary of Health and Human Services and the U.S. Secretary of the Treasury of a State Innovation Waiver application amendment under § 1332 of the Affordable Care Act.
(2)
Within 6 months before a fiscal year in which the Exchange implements the Qualified Resident Enrollment Program, the Exchange shall submit a report to the General Assembly, in accordance with § 2–1257 of the State Government Article, on its plan to implement the Program, including:
(i)
the amount and source of the funding for the Program;
(ii)
the parameters of the Program;
(iii)
the number of individuals anticipated to participate in the Program;
(iv)
the amount of premiums anticipated to be paid by participants under the Program; and
(v)
if the General Assembly authorizes funding to subsidize premiums under the Program, the parameters of the subsidies.
(d)
On or before January 1, 2026, the Exchange shall adopt regulations to carry out this section.
Md. Code Ann., Ins. § 31-125 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–125LinkCopy Citation
(a)
In this section, “Program” means the State–Based Health Insurance Subsidies Program.
(b)
The Exchange, in consultation with the Commissioner and as approved by the Board, shall establish and implement a State–Based Health Insurance Subsidies Program to provide subsidies to individuals for the purchase of health benefit plans in the individual health insurance market.
(c)
The Program required under this section shall be designed to:
(1)
maintain affordability for individuals purchasing health benefit plans through the Exchange; and
(2)
target individuals who experience an increase in the applicable percentages established under 26 U.S.C. § 36B(b)(3)(A)(iii) for premiums based on household income in calendar years 2026 and 2027, as compared to the applicable percentages in place for calendar year 2025.
(d)
Subject to available funds, for calendar years 2026 and 2027, the Exchange, in consultation with the Commissioner and as approved by the Board, shall establish subsidy eligibility and payment parameters for the Program that:
(1)
mitigate a reduction in advance premium tax credits because of changes in the applicable percentages described in subsection (c)(2) of this section;
(2)
maximize enrollment in the individual market;
(3)
take into consideration State funds needed to ensure the State Reinsurance Program continues to provide market stability through calendar year 2028; and
(4)
take into consideration uncertainties in enrollment in the Maryland Medical Assistance Program, the individual market, and the small group market due to changes in State and federal regulation and funding.
(e)
In fiscal years 2026 through 2028, the Exchange may designate funds from the Fund to be used for the Program.
(f)
The Exchange shall adopt regulations to carry out this section.
(g)
(1)
The Exchange shall track on a monthly basis expenditures on subsidies provided under the Program, including:
(i)
the average number of individuals receiving subsidies under the Program;
(ii)
the average subsidy amount received by individuals under the Program; and
(iii)
the impact the Program has on rates in the individual insurance market.
(2)
The information tracked by the Exchange under paragraph (1) of this subsection shall be:
(i)
posted on the website of the Exchange; and
(ii)
included in the annual report required under § 31–119(d) of this subtitle.
Md. Code Ann., Ins. § 31-126 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 1. Maryland Health Benefit Exchange
§ 31–126LinkCopy Citation
The Maryland Health Benefit Exchange shall promote access to health insurance for child care professionals by:
(1)
partnering with:
(i)
the State Department of Education;
(ii)
prekindergarten provider hubs, as defined in § 7–1A–01 of the Education Article;
(iii)
child care associations; and
(iv)
relevant nonprofit organizations;
(2)
helping child care professionals obtain health insurance through the Maryland Health Benefit Exchange or Medicaid;
(3)
assisting child care professionals who lose Medicaid coverage with finding alternative health insurance options;
(4)
helping ensure health plan options meet the budgets and health insurance coverage needs of child care professionals and child care employers;
(5)
providing informational resources, including flyers, webinars, in–person events, and other outreach materials targeted to the child care provider community; and
(6)
assessing current levels of health care access across the child care community by conducting a survey:
(i)
developed in consultation with the State Department of Education and relevant nonprofit organizations; and
(ii)
with a particular emphasis on providers who accept child care scholarship vouchers.
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
Md. Code Ann., Ins. § 31-201 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–201LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(b)
“Advisory Workgroup” means the Maryland Easy Enrollment Health Insurance Program Advisory Workgroup established under § 31–203 of this subtitle.
(c)
“Cost–sharing reduction” means a reduction described in § 1402(c) of the Affordable Care Act.
(d)
“Department” means the Maryland Department of Health.
(e)
“Insurance affordability program” means:
(1)
the Maryland Medical Assistance Program;
(2)
the Maryland Children’s Health Program;
(3)
premium tax credits; or
(4)
cost–sharing reductions.
(f)
“Modified adjusted gross income” has the meaning stated in 42 U.S.C. § 1395r(i)(4)(A).
(g)
“Poverty line” has the meaning stated in 42 U.S.C. § 1397jj(c)(5).
(h)
“Premium tax credits” means the tax credits described in § 36B of the Internal Revenue Code.
(i)
“Proactively contact” means an attempt by the Exchange or the Department to reach an uninsured individual by:
(1)
making multiple attempts to contact the uninsured individual as requested on a State income tax return in accordance with § 2–115(b)(2) of the Tax – General Article;
(2)
if the attempts described in item (1) of this subsection do not successfully reach the uninsured individual or if no specific methods for contacting the uninsured individual were requested, making multiple attempts to contact the uninsured individual through telephonic and electronic means; and
(3)
if the attempts described in items (1) and (2) of this subsection do not successfully reach the uninsured individual to obtain the requested information, sending paper forms or notices to the uninsured individual by mail.
(j)
“Program” means the Maryland Easy Enrollment Health Insurance Program established under § 31–202 of this subtitle.
(k)
“Uninsured individual” means an individual under the age of 65 years who is identified through a State income tax return under § 2–115 of the Tax – General Article as not having minimum essential coverage.
Md. Code Ann., Ins. § 31-202 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–202LinkCopy Citation
(a)
There is a Maryland Easy Enrollment Health Insurance Program.
(b)
The purposes of the Program are to:
(1)
establish a State–based reporting system to provide information about the health insurance status of State residents through the use of State income tax returns to identify uninsured individuals and determine whether an uninsured individual is interested in obtaining minimum essential coverage;
(2)
determine whether an uninsured individual who is interested in obtaining minimum essential coverage qualifies for an insurance affordability program;
(3)
proactively contact an uninsured individual who is interested in obtaining minimum essential coverage to assist in enrolling the uninsured individual in an insurance affordability program and minimum essential coverage; and
(4)
maximize enrollment of eligible uninsured individuals in insurance affordability programs and minimum essential coverage to improve access to care and reduce insurance costs for all residents of the State.
(c)
(1)
The Exchange, the Department, and the Comptroller shall develop and implement systems, policies, and practices that encourage, facilitate, and streamline determination of eligibility for insurance affordability programs and enrollment in minimum essential coverage to achieve the purposes of the Program.
(2)
Except as provided in § 2–115(d) of the Tax – General Article, the systems, policies, and practices shall be:
(i)
operational on or before January 1, 2020; and
(ii)
available for use by residents of the State when filing a State income tax return for taxable years that begin after December 31, 2018.
(d)
To facilitate the most efficient implementation of the Program, the Exchange, the Comptroller, and the Department may:
(1)
enter into agreements;
(2)
adopt regulations;
(3)
adopt guidelines;
(4)
establish accounts;
(5)
conduct trainings;
(6)
provide public information;
(7)
educate tax preparers; and
(8)
take any other steps as may be necessary to accomplish the purpose of the Program.
Md. Code Ann., Ins. § 31-203 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–203LinkCopy Citation
(a)
The Exchange shall establish a Maryland Easy Enrollment Health Insurance Program Advisory Workgroup to provide ongoing advice regarding the implementation of the Program.
(b)
The Advisory Workgroup shall include representation from:
(1)
the Office of the Comptroller;
(2)
consumer groups;
(3)
employers;
(4)
insurers;
(5)
health care providers;
(6)
navigators or other consumer assisters;
(7)
insurance brokers or agents;
(8)
labor organizations;
(9)
income tax preparers;
(10)
national policy experts; and
(11)
any other organizations or groups selected by the Exchange.
(c)
The Advisory Workgroup shall meet at least once every 6 months.
(d)
This section may not be construed to prevent the Exchange from convening other formal or informal working or advisory groups to facilitate the implementation of the Program.
Md. Code Ann., Ins. § 31-204 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–204LinkCopy Citation
(a)
The Exchange or the Department, as applicable, shall determine eligibility for insurance affordability programs as soon as possible after an individual files a State income tax return on which the individual chose a checkoff box described in § 2–115(c)(3) of the Tax – General Article indicating that an uninsured individual may be interested in obtaining minimum essential coverage.
(b)
(1)
To the maximum extent practicable, the Exchange or the Department, as applicable, shall verify an uninsured individual’s eligibility for an insurance affordability program:
(i)
with information on a State income tax return and other data from third–party data sources, including data described in § 1413 of the Affordable Care Act or available under § 2–115(b)(2) of the Tax – General Article; and
(ii)
without requesting additional information or attestations from the uninsured individual.
(2)
If additional attestations or documentation from the uninsured individual are required to establish eligibility for an insurance affordability program, the Exchange or the Department, as applicable, shall take steps to limit the burden on the uninsured individual, including:
(i)
proactively contacting the individual who filed the tax return or the uninsured individual;
(ii)
recording, by telephonic or electronic means, attestations and documentation provided by the individual who filed the tax return or the uninsured individual; and
(iii)
if the attestations or documentation required to determine eligibility are not obtained using the steps described in items (i) and (ii) of this paragraph, facilitating the selection of an authorized representative for the uninsured individual.
(c)
(1)
Before determining eligibility of an uninsured individual for an insurance affordability program, the Exchange or the Department, as applicable, shall attempt to verify the citizenship status of the uninsured individual and each household member listed on the State income tax return, based on the information available from the return and reliable third–party sources of citizenship data.
(2)
If the process described in paragraph (1) of this subsection does not confirm that the uninsured individual and each household member listed on the State income tax return is a United States citizen, the Exchange and the Department may not seek additional verification or take other steps to determine eligibility for or enroll the uninsured individual in an insurance affordability program until the uninsured individual provides affirmative consent using forms and procedures approved by the Exchange.
(3)
The affirmative consent required under paragraph (2) of this subsection may be satisfied through the procedures described in 42 U.S.C. § 1320b–7(d).
(4)
If citizenship is not verified and affirmative consent is not provided in accordance with paragraph (2) of this subsection, the Exchange and the Department may not take any further steps to determine an uninsured individual’s eligibility for or enroll an uninsured individual in an insurance affordability program.
Md. Code Ann., Ins. § 31-205 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–205LinkCopy Citation
(a)
The Exchange or the Department, as applicable, shall make a determination of eligibility, in accordance with § 31–204 of this subtitle, for the Maryland Medical Assistance Program and, if applicable, the Maryland Children’s Health Program under this section, before determining eligibility for any other insurance affordability program.
(b)
(1)
If an uninsured individual is determined to be eligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program, the procedures described in this subsection and guidelines established by the Exchange, in consultation with the Department, to implement this subsection shall apply.
(2)
If an uninsured individual fails to select a managed care organization plan within a period of time established by the Exchange, the Department shall assign the uninsured individual to and promptly enroll the uninsured individual in a managed care organization plan.
(3)
Before the Department assigns an uninsured individual to a managed care organization plan, the uninsured individual shall receive:
(i)
advance notice;
(ii)
an opportunity to select another managed care organization plan within the period of time established by the Exchange; and
(iii)
an opportunity to opt out of coverage.
Md. Code Ann., Ins. § 31-206 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–206LinkCopy Citation
(a)
If an uninsured individual is not determined to be eligible for the Maryland Medical Assistance Program or the Maryland Children’s Health Program under § 31–205 of this subtitle, the Exchange shall determine, in accordance with § 31–204 of this subtitle, whether the uninsured individual is eligible for premium tax credits or cost–sharing reductions as determined under this section.
(b)
(1)
A special or other enrollment period for the individual market shall begin on the date an income tax return is filed by or on behalf of an uninsured individual that includes the choice described in § 2–115(c)(3) of the Tax – General Article, if the return is filed on or before the date specified by the Exchange.
(2)
The enrollment period described in this subsection shall last for a period of time determined by the Exchange before the start of the calendar year that may not be shorter than 14 days.
(c)
(1)
Information about the enrollment period described in subsection (b) of this section shall be communicated to the public and affected individuals through measures that may include language in the instructions for the State individual income tax return, if inclusion of the language is approved by the Comptroller.
(2)
The Exchange is authorized to conduct outreach to individuals described in paragraph (1) of this subsection, using methods that may include written notices and the provision of individualized assistance by insurance agents and brokers, navigators, tax preparers, and Exchange contractors and staff.
(3)
Notwithstanding any other provision of this article, the Exchange may compensate an entity for outreach described in paragraph (2) of this subsection in a manner that reflects, in whole or in part, the number of uninsured individuals enrolled under this section and § 31–204 of this subtitle by that entity.
Md. Code Ann., Ins. § 31-207 (2026)
Title 31. Maryland Health Benefit Exchange
Subtitle 2. Maryland Easy Enrollment Health Insurance Program
§ 31–207LinkCopy Citation
(a)
The Exchange shall develop a detailed set of data privacy and data security safeguards to govern the conveyance, storage, and utilization of data under the Program.
(b)
The safeguards developed under subsection (a) of this section shall ensure that the conveyance, storage, and utilization of data under the Program comply with applicable requirements of federal and State law.