Md. Code Regs. 14.35.16.05

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

Section 14.35.16.05 - Qualified Health Plan Certification-Plan Service Areas

A. As part of a QHP certification application, an authorized carrier shall submit:

(1) A description of the boundaries of the service area of any health benefit plan that is smaller than the State of Maryland; and

(2) For any service area smaller than the State of Maryland, an explanation of the reason for the smaller service area, including a justification that the boundaries are not designed to discriminate against individuals excluded from the health benefit plan's service area.

B. Carriers submitting a justification under §A(2) of this regulation are not required to submit a justification in subsequent years, after the initial justification submission, if there has been no change in the carrier's health benefit plan service areas.

C. After the initial data submission under Regulation .04E of this chapter, a change to a health benefit plan's service area shall be made only by petition to the Exchange and:

(1) Because the carrier cannot secure enough providers; or

(2) Because of an Exchange request to serve an unmet need.

D. After the final data submission under Regulation .04E of this chapter, a change to the health benefit plan's service area shall be permitted only if the change is an expansion of the health benefit plan's service area.

Md. Code Regs. 14.35.16.05

Regulation .05 adopted effective 46:5 Md. R. 309, eff. 3/11/2019