Md. Code Regs. 14.35.15.08

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.15.08 - Requirements for Qualified Plans

A. The authorized carrier shall offer in the Exchange only plans that the Exchange certifies as qualified plans under COMAR 14.35.16.

B. The authorized carrier shall ensure that each of its plans comply with the plan certification requirements in COMAR 14.35.16 on an ongoing basis.

C. An authorized carrier shall offer no more than:

(1) Four benefit designs per metal level in the Individual Exchange and four benefit designs per metal level in the SHOP Exchange in plan year 2024 and prior plan years; and

(2) Three benefit designs per metal level in the Individual Exchange and four benefit designs per metal level in the SHOP Exchange beginning in plan year 2025.

D. An authorized carrier offering stand-alone dental plans shall offer no more than one benefit design at the same actuarial value per network type.

E. As set forth in Insurance Article, § 31-115(b)(5), Annotated Code of Maryland, the authorized carrier:

(1) Shall offer in each Exchange, the Individual and the SHOP, in which the authorized carrier participates, at least one qualified health plan:

(a) At a bronze coverage level;

(b) At a silver coverage level; and

(c) At a gold coverage level;

(2) If the authorized carrier participates in the Individual Exchange and offers any health benefit plan in the individual market outside the Exchange, shall offer at least one qualified health plan at the silver level and one at the gold level in the individual market outside the Exchange;

(3) Shall charge the same premium rate for the same qualified health plan regardless of whether the qualified health plan is offered through the Exchange, through an insurance producer outside the Exchange, or directly from a carrier;

(4) May not vary rates for a SHOP qualified employer during the employer's plan year; and

(5) Shall comply with the prohibition on cancellation fees and penalties for termination of coverage, as set forth in the Insurance Article, § 31-108(d), Annotated Code of Maryland.

Md. Code Regs. 14.35.15.08

Regulation .08 adopted effective 46:5 Md. R. 308, eff. 3/11/2019; amended effective 51:3 Md. R. 154, eff. 2/19/2024.