<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 31.11.06.07" title_num="31" subtitle_num="11" chapter_num="06" heading="Additional Benefits.">
  <paragraph num="A.">
    <text>A carrier may offer benefits in addition to the plan only if:</text>
    <paragraph num="(1)">
      <text>The benefits are offered separately from the plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The benefits are priced separately from the plan;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Subject to the provisions of Insurance Article, §15-1213, Annotated Code of Maryland, the benefits are guarantee issued;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Subject to the provisions of Insurance Article, §15-1212, Annotated Code of Maryland, the benefits are guarantee renewed;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Subject to the provisions of Insurance Article, §15-1205, Annotated Code of Maryland, the benefits are community rated; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The benefits do not duplicate any of the benefits in the plan.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>An additional benefit that a carrier offers shall meet at least one of the following requirements:</text>
    <paragraph num="(1)">
      <text>The benefit increases access to care choices available under the plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The benefit increases the number of services available to covered persons under the plan;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The benefit increases the frequency that covered persons can obtain specified services under the plan; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The benefit lowers the uniform cost-sharing arrangements described in Regulations .04 and .05 of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A health maintenance organization may offer, or may contract with another carrier to offer, a point-of-service option as an additional benefit to the health maintenance organization delivery system or the HMO-HSA delivery system subject to the following requirements:</text>
    <paragraph num="(1)">
      <text>The point-of-service benefit allows a covered person to obtain services outside the network;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For out-of-network services, the health maintenance organization's coinsurance percentage shall be no less than the percentage of allowable charges specified in Regulations .04F and .05B of this chapter; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The health maintenance organization may limit the benefits a covered person may obtain outside the network.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>An insurer or nonprofit health service plan offering an exclusive provider delivery system or an EPO-HSA delivery system specified under this chapter may offer a limited out-of-network additional benefit as defined under Regulation .02 of this chapter as an additional benefit subject to the following requirements:</text>
    <paragraph num="(1)">
      <text>The limited out-of-network additional benefit allows a covered person to obtain services outside the network;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Except as specified in §D(4) of this regulation, for out-of-network services, the insurer's or nonprofit health service plan's coinsurance may not be less than 60 percent of allowable charges;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The insurer or nonprofit health service plan may limit the benefits a covered person may obtain outside the network; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For outpatient services for mental health and substance abuse, rehabilitation, and chiropractic services received out-of-network, the insurer's or nonprofit health service plans' coinsurance may not be less than 50 percent of allowable charges.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>A carrier may offer a rider to cover the services of Christian Science practitioners and Christian Science facilities.</text>
  </paragraph>
</regulation>