<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 14.35.16.04" title_num="14" subtitle_num="35" chapter_num="16" heading="Qualified Health Plan Certification — Application.">
  <paragraph num="A.">
    <text>Each authorized carrier shall annually submit an application, in a form specified by the Annual Letter to Issuers, for each health benefit plan intended to be certified as a QHP to be offered on the Exchange.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A carrier shall submit a completed application, including all required information and submissions under this regulation, to the Exchange.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The Exchange shall notify a carrier of the application status within 45 days of receipt of a completed application.</text>
  </paragraph>
  <paragraph num="D.">
    <text>If an application is determined incomplete, the Exchange shall notify a carrier of the application status within 45 days of the initial submission.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Information Submission.</text>
    <paragraph num="(1)">
      <text>An authorized carrier shall submit an initial submission containing the information required under §§E and F of this regulation and Regulations .04—.10 of this chapter as part of the application under §B of this regulation and detailed through the Annual Letter to Issuers.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If requested by the Exchange, an authorized carrier shall submit a supplement to its initial submission under §E(1) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>In accordance with Insurance Article, §31-115(g)(2), Annotated Code of Maryland, upon request, an authorized carrier shall provide in its application a description of the health benefit plan, in plain language and in a form specified by the Annual Letter to Issuer, that includes:</text>
    <paragraph num="(1)">
      <text>Claims payment policies and practices;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Data on enrollment, disenrollment, number of claims denied (including in whole and in part), and rating practices, if applicable;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Information on cost sharing and payments with respect to any out-of-network coverage; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Any other information as determined appropriate by the Exchange.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>An authorized carrier shall provide in its application, in a form specified in the Annual Letter to Issuers, the following information about the health benefit plan:</text>
    <paragraph num="(1)">
      <text>Plan, benefit, and cost sharing;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Plan information for the renewal of QHP enrollment;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Unified rate review template;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Prescription drug cost sharing and formulary;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provider network;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Service area, including justifications for partial county service areas;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Rate and premiums;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Actuarial information required to be submitted to the Exchange under 45 CFR §155.1030(b);</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Provider directory data as specified in Regulation .07 of this chapter;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Summaries of benefits and coverage, under 45 CFR §147.200, for each cost-sharing reduction variation;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Essential community providers contracted to participate within the health benefit plan’s provider network; and</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Any other information the carrier would like to provide to the Exchange to supplement the application.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>An authorized carrier shall comply with the rate and form review procedures, including review of compliance with essential health benefits requirements, established by the Commissioner.</text>
  </paragraph>
  <paragraph num="I.">
    <text>Data and information submitted to the Exchange may be provided to the Commissioner, if requested, for consideration in the Commissioner’s annual QHP rate and form review process.</text>
  </paragraph>
  <paragraph num="J.">
    <text>The authorized carrier shall provide to the Exchange the rate justification forms filed with the Commissioner for each QHP certification application the authorized carrier submits to the Exchange.</text>
  </paragraph>
</regulation>