§ 15-1204. Requirements and limitations for carriers[Subject to amendment effective January 1, 2014; amended version follows this section]

   (a) In general. -- In addition to any other requirement under this article, a carrier shall:

   (1) have demonstrated the capacity to administer the health benefit plan, including adequate numbers and types of administrative personnel;

   (2) have a satisfactory grievance procedure and ability to respond to enrollees' calls, questions, and complaints;

   (3) provide, in the case of individuals covered under more than one health benefit plan, for coordination of coverage under all of those health benefit plans in an equitable manner; and

   (4) design policies to help ensure adequate access to providers of health care.

(b) Standard Plan required. -- A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.

(c) Less than minimum coverage prohibited. -- A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.

(d) Optional additional coverage. -- A carrier may offer benefits in addition to those in the Standard Plan if:

   (1) the additional benefits:

      (i) are offered and priced separately from benefits specified in accordance with § 15-1207 of this subtitle; and

      (ii) do not have the effect of duplicating any of those benefits; and

   (2) the carrier:

      (i) clearly distinguishes the Standard Plan from other offerings of the carrier;

      (ii) indicates the Standard Plan is the only plan required by State law; and

      (iii) specifies that all enhancements to the Standard Plan are not required by State law.

(e) Point of service delivery system. -- Notwithstanding subsection (b) of this section, a health maintenance organization may provide a point of service delivery system as an additional benefit through another carrier regardless of whether the other carrier also offers the Standard Plan.

(f) Dental care. -- A carrier may offer coverage for dental care and services as an additional benefit.

(g) Offerings of wellness benefits. --

   (1) In this subsection, "prominent carrier" means a carrier that insures at least 10% of the total lives insured in the small group market.

   (2) (i) A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.

      (ii) A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.

   (3) 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.

HISTORY: An. Code 1957, art. 48A, § 699; 1997, ch. 35, § 2; 2003, ch. 93; 2004, ch. 287, § 2; 2007 Sp. Sess., ch. 7, § 2.