"MARYLAND HEALTH INSURANCE REFORM ACT COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN DISCLOSURE STATEMENT
Under Maryland law, small employers, including self-employed individuals and certain government and nonprofit organizations, as defined by Insurance Article, § 15-1203, Annotated Code of Maryland, must be offered the Comprehensive Standard Health Benefit Plan ("Standard Plan") by each carrier when health coverage is elected or renewed.
A carrier may not offer small employers a health benefit plan having fewer benefits than the Standard Plan. A carrier may offer benefits in addition to those in the Standard Plan provided the optional, additional benefits are offered and priced separately from the Standard Plan. A small employer who is subject to the federal Mental Health Parity and Addiction Equity Act of 2008 shall be offered, at a minimum, the Standard Plan plus an additional benefit rider to make the mental health and substance abuse benefits comply with the federal Mental Health Parity and Addiction Equity Act of 2008.
I HAVE READ AND UNDERSTAND THIS DISCLOSURE STATEMENT. I ACKNOWLEDGE THAT I HAVE RECEIVED A DESCRIPTION OF THE STANDARD PLAN AND RATES AND ANY ADDITIONAL BENEFITS AND RATES HAVE BEEN SHOWN AND PRICED SEPARATELY.
Name of Carrier:
Name of Producer:
Employer Name:
Employer Signature: Date: ".
Md. Code Regs. 31.11.11.03