§ 15-1A-09
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§15–1A–09.
(a)Except as provided in subsections
(b)through
(d)of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article:
(1)Subtitle 4 of this title;
(2)§§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title;
(3)§§ 15–1316 and 15–1318 of this title; and
(4)§§ 15–1406 and 15–1406.1 of this title.
(1)Except as provided in paragraph
(2)of this subsection, a carrier may restrict enrollment to open or special enrollment periods.
(2)A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year.
(c)If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier:
(i)may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and
(ii)if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or
(2)may deny coverage within a service area if the carrier:
(i)demonstrates to the Commissioner that:
1. the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and
2. the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and
(ii)does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area.
(d)A carrier may deny coverage if the carrier:
(1)demonstrates to the Commissioner that:
(i)the carrier does not have the financial reserves necessary to underwrite additional coverage; and
(ii)the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and
(2)unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.