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PARRIS N. GLENDENING, Governor
Article - Insurance
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Ch. 153
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15-1303.
(A) In addition to any other requirements under this article, a carrier that
offers individual health benefit plans in this State shall:
(1) have demonstrated the capacity to administer the individual health
benefit plans, including adequate numbers and types of administrative staff;
(2) have a satisfactory grievance procedure and ability to respond to
calls, questions, and complaints from enrollees or insureds; and
(3) design policies to help ensure that enrollees or insureds have
adequate access to providers of health care.
(B) (1) FOR EACH CALENDAR QUARTER A CARRIER THAT OFFERS
INDIVIDUAL HEALTH BENEFIT PLANS IN THE STATE SHALL SUBMIT TO THE
COMMISSIONER A REPORT THAT INCLUDES:
(I) THE NUMBER OF APPLICATIONS SUBMITTED TO THE CARRIER
FOR INDIVIDUAL COVERAGE; AND
(II) THE NUMBER OF DECLINATIONS ISSUED BY THE CARRIER FOR
INDIVIDUAL COVERAGE.
(2) THE REPORT REQUIRED UNDER PARAGRAPH (1) OF THIS
SUBSECTION SHALL BE FILED WITH THE COMMISSIONER NO LATER THAN 30 DAYS
AFTER THE LAST DAY OF THE QUARTER FOR WHICH THE INFORMATION IS
PROVIDED.
(C) (1) IF A CARRIER DENIES COVERAGE UNDER A MEDICALLY
UNDERWRITTEN HEALTH BENEFIT PLAN TO AN INDIVIDUAL IN THE NONGROUP
MARKET, THE CARRIER SHALL PROVIDE THE INDIVIDUAL WITH SPECIFIC
INFORMATION REGARDING THE AVAILABILITY OF COVERAGE UNDER THE
MARYLAND HEALTH INSURANCE PLAN ESTABLISHED UNDER TITLE 14, SUBTITLE 5
OF THIS ARTICLE.
(2) A NOTICE ISSUED BY A CARRIER UNDER THIS SUBSECTION SHALL BE
PROVIDED IN A MANNER AND FORM REQUIRED BY THE COMMISSIONER
15-1305. 15-1309.
(b) A carrier may not cancel or refuse to renew an individual health benefit
plan except:
(1) for nonpayment of the required premiums;
(2) where the individual has performed an act or practice that
constitutes fraud;
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(3) where the individual has made an intentional misrepresentation of
material fact under the terms of the coverage;
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- 1539 -
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