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§ 15-1A-19. Cost-sharing

West's Annotated Code of MarylandInsuranceEffective: May 8, 2020

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 1a--Consumer Protections (Refs & Annos)
Effective: May 8, 2020
MD Code, Insurance, § 15-1A-19
§ 15-1A-19. Cost-sharing
“Cost-sharing” defined
(a)(1) In this section, “cost-sharing” means any expenditure required by or on behalf of an insured individual with respect to essential health benefits.
(2) “Cost-sharing” includes:
(i) deductibles, coinsurance, copayments, or similar charges; and
(ii) any other expenditure required of an insured individual that is a qualified medical expense, as defined in 26 U.S.C. § 223(d)(2), with respect to essential health benefits covered under the plan.
(3) “Cost-sharing” does not include premiums, balance billing amounts for nonnetwork providers, or spending for noncovered services.
Annual limitations
(b)(1) Except as provided in paragraph (2) of this subsection, each carrier shall comply with annual limitations on cost-sharing for essential health benefits covered under health benefit plans as established by 45 C.F.R. § 156.130.
(2) If the Commissioner adopts regulations as described in subsection (c) of this section, each carrier shall comply with the adopted regulations.
(c) To the extent necessary, the Commissioner shall adopt regulations that:
(1) establish annual limitations on cost-sharing; and
(2) are consistent with 45 C.F.R. § 156.130 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.


Added by Acts 2020, c. 620, § 1, eff. May 8, 2020; Acts 2020, c. 621, § 1, eff. May 8, 2020.
MD Code, Insurance, § 15-1A-19, MD INSURANCE § 15-1A-19
Current through all legislation from the 2022 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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