{"data":{"id":"us-md/md.-code-insurance-15-1204","jurisdiction":"us-md","citation":"Md. Code, Insurance § 15–1204","heading":"","body":"(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.\n(b) In addition to any other requirement under this article, a carrier shall:\n(1) have demonstrated the capacity to administer the health benefit plan, including adequate numbers and types of administrative personnel;\n(2) have a satisfactory grievance procedure and ability to respond to enrollees’ calls, questions, and complaints;\n(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\n(4) design policies to help ensure adequate access to providers of health care.\n(c) A person may not offer a health benefit plan in the State unless the person offers at least the Standard Plan.\n(d) A carrier may not offer a health benefit plan that has fewer benefits than those in the Standard Plan.\n(e) A carrier may offer benefits in addition to those in the Standard Plan if:\n(1) the additional benefits:\n(i) are offered and priced separately from benefits specified in accordance with § 15–1207 of this subtitle; and\n(ii) do not have the effect of duplicating any of those benefits; and\n(2) the carrier:\n(i) clearly distinguishes the Standard Plan from other offerings of the carrier;\n(ii) indicates the Standard Plan is the only plan required by State law; and\n(iii) specifies that all enhancements to the Standard Plan are not required by State law.\n(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.\n(g) A carrier may offer coverage for dental care and services as an additional benefit.\n(h) (1) In this subsection, “prominent carrier” means a carrier that insures at least 10% of the total lives insured in the small group market.\n(2) (i) A prominent carrier shall offer a wellness benefit for a health benefit plan offered under this subtitle.\n(ii) A carrier that is not a prominent carrier may offer a wellness benefit for a health benefit plan offered under this subtitle.\n(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.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=15-1204","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"fb240f8cac5d9bcc89f3525f753a083020c13cbc5641a87dd5b5d3704ae35d9a","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-15-1202","next":"us-md/md.-code-insurance-15-1204.1"},"notice":"GroundRules: Original legal text. Not legal advice."}