1. (a) This section applies to a carrier with respect to any health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act.

2. (b) In addition to any other requirement under this article, a carrier shall:

   1. (1) have demonstrated the capacity to administer the health benefit plan, including adequate numbers and types of administrative personnel;
   2. (2) have a satisfactory grievance procedure and ability to respond to enrollees' calls, questions, and complaints;
   3. (3) provide, in the case of individuals covered under more than one health benefit plan, for coordination of coverage under all of those health benefit plans in an equitable manner; and
   4. (4) design policies to help ensure adequate access to providers of health care.
3. (c) A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.
4. (d) A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.

5. (e) A carrier may offer benefits in addition to those in the Standard Plan if:

   1. (1) the additional benefits:

      1. (i) are offered and priced separately from benefits specified in accordance with § 15-1207 of this subtitle; and
      2. (ii) do not have the effect of duplicating any of those benefits; and

   2. (2) the carrier:

      1. (i) clearly distinguishes the Standard Plan from other offerings of the carrier;
      2. (ii) indicates the Standard Plan is the only plan required by State law; and
      3. (iii) specifies that all enhancements to the Standard Plan are not required by State law.
6. (f) Notwithstanding subsection (c) of this section, a health maintenance organization may provide a point of service delivery system as an additional benefit through another carrier regardless of whether the other carrier also offers the Standard Plan.
7. (g) A carrier may offer coverage for dental care and services as an additional benefit.

8. (h)

   1. (1) In this subsection, “prominent carrier” means a carrier that insures at least 10% of the total lives insured in the small group market.

   2. (2)

      1. (i) A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.
      2. (ii) A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.
   3. (3) A carrier may not condition the sale of a wellness benefit to a small employer on participation of the eligible employees of the small employer in wellness programs or activities.

Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997; Amended by Acts 2003, c. 93, § 1, eff. July 1, 2003; Acts 2004, c. 287, § 2, eff. July 1, 2004; Acts 2007, 1st Sp. Sess., c. 7, § 2, eff. Nov. 19, 2007; Acts 2012, c. 152, § 2, eff. Jan. 1, 2014.

Formerly Art. 48A, § 699.