Chapter 14. Wellness Benefits Under Small Employer Health Benefit Plans
Regulation .01 Purpose.LinkCopy Citation
This chapter specifies the requirements for:
A.
A wellness benefit offered by a carrier to a small employer under Insurance Article, Title 15, Subtitle 12, Annotated Code of Maryland;
B.
Determining if a carrier is considered a prominent carrier; and
C.
Carriers offering wellness benefits to small employers.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Carrier” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
(2)
“Case management program” means a program that involves a collaborative process of assessment, planning, implementation, coordination, monitoring, and evaluation of the options and services required to meet an individual's health needs through communication and available resources to promote quality cost effective outcomes.
(3)
“Disease management program” means a program of preventive, diagnostic, and therapeutic services for certain patients that are considered to be at risk.
(4)
“Eligible employee” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
(5)
“Health benefit plan” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
(6)
“Health risk assessment” means a self-reported health questionnaire that:
(a)
Asks a variety of personal questions about lifestyle and behavioral habits, such as physical activity level, eating habits, and stress; and
(b)
Includes, but is not limited to, biometric measures and other health status information.
(7)
“Preventive services” means the services required to be covered under the small employer standard plan, as described in COMAR 31.11.06.03A(9).
(8)
“Prominent carrier” means a carrier that insures at least 10 percent of the total lives insured in the Maryland small group market.
(9)
“Small employer” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
(10)
“Standard plan” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
(11)
“Wellness benefit”:
(a)
Has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland; and
(b)
Complies with the requirements set forth in Regulations .03 and .04 of this chapter.
(12)
“Wellness program” has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.
Regulation .03 Components of a Wellness Benefit.LinkCopy Citation
A.
Each wellness benefit shall include:
(1)
A health risk assessment that is:
(a)
Available at no cost to all employees covered under the small employer's wellness benefit; and
(b)
Completed by each employee on a voluntary basis;
(2)
Written feedback to each employee who completes the health risk assessment, with recommendations for lowering risks identified in the completed health risk assessment; and
(3)
A financial incentive to promote:
(a)
Preventive care;
(b)
Healthy behavior and lifestyle choices; or
(c)
Participation in a disease management program or case management program.
B.
The financial incentive described in §A(3) of this regulation may be in the form of:
(1)
A direct reward of financial value given to the employee, such as a monetary reward or a gift card; or
(2)
A reduction in the employee's copayments, coinsurance, or deductible that would otherwise be payable under the small employer's health benefit plan.
C.
A carrier shall be considered to have satisfied the requirement of §A(3) of this regulation, if the wellness benefit offered by the carrier eliminates the deductible for preventive services only.
Regulation .04 General Requirements for Wellness Benefits Offered to Small Employers.LinkCopy Citation
A.
A wellness benefit offered to a small employer:
(1)
Shall satisfy the requirements of an additional benefit found in COMAR 31.11.06.07; and
(2)
May not violate any requirement regarding wellness programs as described in 45 CFR §146.121.
B.
A wellness benefit may appear in an additional benefit rider as the only benefit in the rider, or it may be bundled with other benefits in an additional benefit rider.
Regulation .05 Requirement for Carriers to Offer a Wellness Benefit.LinkCopy Citation
A.
A prominent carrier shall offer a wellness benefit to a small employer for a health benefit plan offered in Maryland.
B.
A carrier that is not a prominent carrier may offer a wellness benefit to a small employer for a health benefit plan offered in Maryland.
C.
The determination of which carriers are prominent carriers shall be determined each calendar year, based on the market share that each carrier had of the Maryland small group market for the prior calendar year.
D.
A carrier may not condition the sale of a wellness benefit to a small employer on participation of the eligible employees of the small employer in wellness programs or activities.
Chapter annotations
Authority: Health General Article, §19-108; Insurance Article, §§2-109, 15-1201, 15-1204(g), and 15-1207(a); Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.05 adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 896); adopted permanently effective July 17, 2008 (35:14 Md. R. 1248)
History: Regulation .02B amended effective October 19, 2009 (36:21 Md. R. 1594)
History: Regulation .05A amended effective October 19, 2009 (36:21 Md. R. 1594)