Md. Code Regs. 31.11.06.01

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.11.06.01 - Scope

A. This chapter applies to all carriers that offer the comprehensive standard health benefit plan to the small employer market.

B. This chapter identifies the uniform benefits which must be offered in a comprehensive standard health benefit plan which a carrier offers to a Maryland small employer if the policy is issued or renewed after June 30, 1994. A carrier participating in the small employer market shall market this plan to all employers with as few as two eligible employees and as many as 50 eligible employees.

C. With the exception set forth in §D of this regulation, a carrier may offer the plan through one or more of the following delivery systems:

(1) Indemnity;

(2) Preferred provider;

(3) Point-of-service delivered in conjunction with an indemnity or preferred provider delivery system;

(4) A health maintenance organization;

(5) A high deductible health maintenance organization;

(6) A triple option point-of-service;

(7) An HSA-compatible delivery system; or

(8) An exclusive provider.

D. This chapter also specifies the uniform cost-sharing arrangements of the plan applicable to each delivery system. This chapter permits carriers to offer additional benefits or lower cost-sharing arrangements by marketing one or more riders to the plan at an additional cost.

E. A carrier that offers the comprehensive standard health benefit plan to an eligible employer shall offer the plan to all eligible employees. An eligible employer may, at the employer's election, direct the carrier to offer the comprehensive standard health benefit plan to the employer's part-time employees and those employees covered by other public or private health benefit plans or health benefit arrangements, and to all dependents.

F. This chapter includes case management for medically complex and costly services to assure adequate cost containment and appropriate utilization to maximize the affordability of the comprehensive standard health benefit plan to the small employer market.

Md. Code Regs. 31.11.06.01

Regulation .01 amended effective May 18, 1998 (25:10 Md. R. 746)
Regulation .01 amended effective April 10, 2006 (33:7 Md. R. 675)
Regulation .01C amended effective April 9, 2007 (34:7 Md. R. 700); March 24, 2008 (35:6 Md. R. 702)