§ 15-1A-03
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§15–1A–03.
(a)For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that:
(1)establish criteria that a health benefit plan must meet to be considered a grandfathered plan; and
(2)are consistent with 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.
(b)Except as otherwise provided in this subtitle and subject to subsection
(c)of this section, this subtitle applies to any health benefit plan that is offered by a carrier in the State within the scope of:
(1)Subtitle 12 of this title;
(2)Subtitle 13 of this title; or
(3)Subtitle 14 of this title.
(1)Except as provided in paragraph
(2)of this subsection, the provisions of this subtitle do not apply to a grandfathered plan.
(i)The following provisions apply to all grandfathered plans:
1. the provisions of § 15–1A–08 of this subtitle related to health benefit plans that provide dependent coverage of a child;
2. the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing lifetime limits on the dollar value of benefits;
3. the provisions of § 15–1A–12 of this subtitle related to waiting periods;
4. the provisions of § 15–1A–13 of this subtitle related to choice of provider;
5. the provisions of § 15–1A–14 of this subtitle related to coverage of emergency services;
6. the provisions of § 15–1A–15 of this subtitle related to summary of benefits and coverage requirements;
7. the provisions of § 15–1A–16 of this subtitle related to medical loss ratio and corresponding reporting and rebate requirements; and
8. the provisions of § 15–1A–21 of this subtitle related to rescission of a health benefit plan.
(ii)The following provisions apply to all grandfathered plans except grandfathered plans that are individual plans:
1. the provisions of § 15–1A–05 of this subtitle related to preexisting condition exclusions; and
2. the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing annual limits on the dollar value of benefits.