§ 15-1205. Community and premium rates for health benefit plans
West's Annotated Code of MarylandInsuranceEffective: June 1, 2019
Effective: June 1, 2019
MD Code, Insurance, § 15-1205
§ 15-1205. Community and premium rates for health benefit plans
(a)(1) This subsection applies to a carrier with respect to any health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act.
(b)(1) This subsection applies to a carrier with respect to any health benefit plan that:
(c)(1) A carrier shall apply all risk adjustment factors under subsections (a) and (g) of this section consistently with respect to all health benefit plans that are:
(d)(1) This subsection applies to a carrier with respect to any health benefit plan that is a grandfathered health plan.
Rating methods and practices based on commonly accepted actuarial assumptions and sound actuarial principles
(e)(1) A carrier shall base its rating methods and practices on commonly accepted actuarial assumptions and sound actuarial principles.
(f)(1) This subsection applies to a carrier with respect to any health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act.
(2) A carrier may offer an administrative discount to a small employer if the small employer elects to purchase, for its employees, an annuity, dental insurance, disability insurance, life insurance, long-term care insurance, vision insurance, or, with the approval of the Commissioner, any other insurance sold by the carrier.
(g)(1) A carrier may adjust the community rate for a health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act, for health status only if a small employer has not offered a health benefit plan issued under this subtitle to its employees in the 12 months prior to the initial enrollment of the small employer in the health benefit plan.
(3) For a health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act, a carrier may use health statements, in a form approved by the Commissioner, and health screenings to establish an adjustment to the community rate for health status as provided in this subsection.
(5) It is an unfair trade practice for a carrier knowingly to provide coverage to a small employer that discriminates against an employee or applicant for employment, based on the health status of the employee or applicant or a dependent of the employee or applicant, with respect to participation in a health benefit plan sponsored by the small employer.
Credits
Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 1997, c. 635, § 9, eff. July 1, 1997; Acts 1997, c. 636, § 9, eff. July 1, 1997; Acts 1999, c. 671, § 1, eff. June 1, 1999; Acts 2000, c. 569, § 1, eff. June 1, 2000; Acts 2007, c. 243, § 1, eff. Oct. 1, 2007; Acts 2007, c. 600, § 1, eff. July 1, 2007; Acts 2009, c. 577, § 3, eff. July 1, 2010; Acts 2009, c. 578, § 3, eff. July 1, 2010; Acts 2012, c. 152, § 2, eff. Jan. 1, 2014; Acts 2013, c. 368, § 3, eff. Jan. 1, 2014; Acts 2019, c. 6, § 1, eff. June 1, 2019.
MD Code, Insurance, § 15-1205, MD INSURANCE § 15-1205
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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