§ 31-116
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/md/insurance/31-116A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§31–116.
(a)The essential health benefits required under § 1302(a) of the Affordable Care Act:
(1)shall be the benefits in the State benchmark plan, selected in accordance with this section; and
(2)notwithstanding any other benefits mandated by State law, shall be the benefits required in:
(i)subject to subsection
(f)of this section, all individual health benefit plans and health benefit plans offered to small employers, except for grandfathered health plans, as defined in the Affordable Care Act, offered outside the Exchange; and
(ii)all qualified health plans offered in the Exchange.
(b)In selecting the State benchmark plan, the State seeks to:
(1)balance comprehensiveness of benefits with plan affordability to promote optimal access to care for all residents of the State;
(2)accommodate to the extent practicable the diverse health needs across the diverse populations within the State; and
(3)ensure the benefit of input from the stakeholders and the public.
(1)The State benchmark plan, for 2017 and until the Secretary requires that a new benchmark plan be selected, shall be selected by the Commissioner, in consultation with the Exchange:
(i)based on enrollment for the first quarter of 2014, from the largest health plan by enrollment in any of the three largest small group insurance products by enrollment in the State’s small group market; and
(ii)through an open, transparent, and inclusive process, which shall include at least one public hearing and an opportunity for public comment.
(2)In selecting the State benchmark plan, the Commissioner, in consultation with the Exchange, may exclude, consistent with applicable federal regulations:
(i)a health care service, benefit, coverage, or reimbursement for covered health care services that is required under this article or the Health – General Article to be provided or offered in a health benefit plan that is issued or delivered in the State by a carrier; or
(ii)reimbursement required by statute, by a health benefit plan for a service when that service is performed by a health care provider who is licensed under the Health Occupations Article and whose scope of practice includes that service.
(d)In selecting the State benchmark plan, the Commissioner, in consultation with the Exchange, shall:
(1)select a plan that complies with all requirements of this subtitle and the Affordable Care Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and any other federal laws, regulations, policies, or guidance applicable to state benchmark plans and essential health benefits;
(2)for individual health benefit plans, require that the health benefit plans include any mandated benefits that were required in individual health benefit plans before December 31, 2011, if the benefits are not included in the selected benchmark plan; and
(3)if the selected state benchmark plan does not comply with any federal benefit requirement, supplement the required benefits, to the extent permitted by federal law, with benefits similar to those chosen by the Maryland Health Care Reform Coordinating Council in 2012.
(e)Within 10 days after selecting the State benchmark plan, the Commissioner shall submit a report, in accordance with § 2–1257 of the State Government Article, to the Senate Finance Committee and the House Health and Government Operations Committee advising the Committees of the Commissioner’s selection and the process used in making the selection.
(i)In this subsection the following words have the meanings indicated.
(ii)“Exchange certified stand–alone dental plan” means a stand–alone dental plan that has been certified by the Exchange for sale outside the Exchange under § 31–115 of this subtitle.
(iii)“Purchaser” means:
1. with respect to an individual health benefit plan, the individual applying for coverage; and
2. with respect to a small group health benefit plan, the employer applying for coverage.
(2)To the extent permitted under federal law, a health benefit plan offered outside the Exchange to individuals or small employers is not required to provide pediatric dental essential health benefits if:
(i)at the time the carrier offers the health benefit plan, the carrier discloses in a form approved by the Commissioner that the health benefit plan does not provide the full range of pediatric dental essential health benefits; and
(ii)the carrier is reasonably assured that the enrollee has obtained full coverage of pediatric dental essential health benefits through an Exchange certified stand–alone dental plan.
(3)A carrier shall:
(i)disclose to a potential purchaser, for those health benefit plans sold outside the Exchange that do not provide the pediatric dental essential health benefits, that the plan does not include the pediatric dental essential health benefits; and
(ii)for those health benefit plans sold outside the Exchange that do not provide the pediatric dental essential health benefits, include on its application completed by a purchaser the following:
“Have you obtained stand–alone dental coverage that provides pediatric dental essential health benefits through a Maryland Health Benefit Exchange certified stand–alone dental plan offered outside the Maryland Health Benefit Exchange?
Yes ____ No ____
If you answered “Yes”, please provide the name of the company issuing the stand–alone dental coverage.
If you answered “No”, you will be issued a health benefit plan that includes the pediatric dental essential health benefits.”
(4)The Administration shall place on its website a list of the Exchange certified stand–alone dental plans in the State.