§ 15-1A-18
271 words·~1 min read·
/md/insurance/15-1a-18A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1A–18.
(a)A carrier may offer a catastrophic plan in the individual market in accordance with the requirements of this section.
(b)A catastrophic plan may be offered only to individuals who:
(1)are under the age of 30 years before the beginning of the plan year; or
(2)hold certification for a hardship exemption or an affordability exemption as required in subsection
(c)of this section.
(1)Except as provided in paragraph
(2)of this subsection, to be offered a catastrophic plan, an individual shall hold certification for a hardship exemption or an affordability exemption under 42 U.S.C. § 5000A.
(2)If the Maryland Health Benefit Exchange adopts regulations as described under subsection
(d)of this section, an individual shall hold certification for a hardship exemption or an affordability exemption under the regulations adopted by the Exchange.
(d)To the extent necessary, the Maryland Health Benefit Exchange shall adopt regulations that:
(1)establish a process for issuing hardship exemptions and affordability exemptions; and
(2)are consistent with 42 U.S.C. § 5000A and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.
(1)Subject to paragraph
(2)of this subsection, a catastrophic plan shall provide coverage for essential health benefits.
(2)A catastrophic plan shall require a deductible that:
(i)is equal to the annual limit on cost–sharing described in § 15–1A–19 of this subtitle;
(ii)applies to essential health benefits;
(iii)does not apply to at least three primary care visits each plan year; and
(iv)does not apply to any covered benefits for which a deductible is prohibited under this title.