EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb0604*
HOUSE BILL 604
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CF 3lr1248
By: Delegate Qi
Introduced and read first time: February 3, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Health Benefit Plans Issued Through Professional Employer 2
Organizations – Exemption 3
FOR the purpose of exempting from certain requirements relating to the offering of health 4
benefit plans to individuals and small employers in the State health benefit plans 5
issued through a professional employer organization, coemployer, or other 6
organization located in the State or another state that engages in employee leasing; 7
and generally relating to health benefit plans issued through professional employer 8
organizations, coemployers, and other organizations that engage in employee 9
leasing. 10
BY repealing and reenacting, with amendments, 11
Article – Insurance 12
Section 15–1204.1 and 15–1303 13
Annotated Code of Maryland 14
(2017 Replacement Volume and 2022 Supplement) 15
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
That the Laws of Maryland read as follows: 17
Article – Insurance 18
15–1204.1. 19
(a) (1) This section applies to a carrier with respect to any health benefit plan 20
that: 21
[(1)] (I) is not a grandfathered health plan, as defined in § 1251 of the 22
Affordable Care Act; and 23
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[(2)] (II) is issued, delivered, or renewed in the State on or after January 1
1, 2014. 2
(2) THIS SECTION DOES NOT APPLY TO A HEALTH BENEFIT PLAN 3
ISSUED THROUGH A PRO FESSIONAL EMPLOYER O RGANIZATION, COEMPLOYER , OR 4
OTHER ORGANIZATION L OCATED IN THIS STATE OR ANOTHER STAT E THAT ENGAGES 5
IN EMPLOYEE LEASING . 6
(b) (1) Except as provided in this subsection and § 31–110(f) of this article, a 7
carrier may not offer health benefit plans to small employers in the State unless the carrier 8
also offers qualified health plans, as defined in § 31–101 of this article, in the Small 9
Business Health Options Program of the Maryland Health Benefit Exchange in compliance 10
with the requirements of Title 31 of this article. 11
(2) A carrier is exempt from the requirement in paragraph (1) of this 12
subsection if: 13
(i) the reported total aggregate annual earned premium from all 14
health benefit plans offered to small employers in the State for the carrier and any other 15
carriers in the same insurance holding company system, as defined in § 7–101 of this 16
article, is less than $20,000,000; 17
(ii) the Commissioner determines that the carrier complies with the 18
procedures established under paragraph (3) of this subsection; and 19
(iii) when the carrier ceases to meet the requirements for the 20
exemption, the carrier provides to the Commissioner immediate notice and its plan for 21
complying with the requirement in paragraph (1) of this subsection. 22
(3) The Commissioner shall establish procedures for a carrier to submit 23
evidence each year that the carrier meets the requirements necessary to qualify for an 24
exemption under paragraph (2) of this subsection. 25
(4) Notwithstanding the exemption provided in paragraph (2) of this 26
subsection, the Commissioner, in consultation with the Maryland Health Benefit 27
Exchange: 28
(i) may assess the impact of the exemption provided in paragraph 29
(2) of this subsection and, based on that assessment, alter the limit on the amount of annual 30
premiums that may not be exceeded to qualify for the exemption; and 31
(ii) shall make any change in the exemption requirement by 32
regulation. 33
15–1303. 34
HOUSE BILL 604 3
(A) THIS SECTION DOES NOT APPLY TO AN INDIVIDUAL HEALTH BE NEFIT 1
PLAN ISSUED THROUGH A PROFESSIONAL EMPLO YER ORGANIZATION , 2
COEMPLOYER , OR OTHER ORGANIZATIO N LOCATED IN THIS STATE OR ANOTHER 3
STATE THAT ENGAGES I N EMPLOYEE LEASING . 4
[(a)] (B) In addition to any other requirements under this article, a carrier that 5
offers individual health benefit plans in the State shall: 6
(1) have demonstrated the capacity to administer the individual health 7
benefit plans, including adequate numbers and types of administrative staff; 8
(2) have a satisfactory grievance procedure and ability to respond to calls, 9
questions, and complaints from enrollees or insureds; and 10
(3) design policies to help ensure that enrollees or insureds have adequate 11
access to providers of health care. 12
[(b)] (C) (1) Except as provided in this subsection and § 31–110(f) of this 13
article, a carrier may not offer individual health benefit plans in the State unless the carrier 14
also offers qualified health plans, as defined in § 31–101 of this article, in the Individual 15
Exchange of the Maryland Health Benefit Exchange in compliance with the requirements 16
of Title 31 of this article. 17
(2) A carrier is exempt from the requirement in paragraph (1) of this 18
subsection if: 19
(i) 1. the reported total aggregate annual earned premium from 20
all individual health benefit plans in the State for the carrier and any other carriers in the 21
same insurance holding company system, as defined in § 7–101 of this article, is less than 22
$10,000,000; or 23
2. the only individual health benefit plans that the carrier 24
offers in the State are student health plans as defined in 45 C.F.R. § 147.145; 25
(ii) the Commissioner determines that the carrier complies with the 26
procedures established under paragraph (3) of this subsection; and 27
(iii) when the carrier ceases to meet the requirements for the 28
exemption, the carrier provides to the Commissioner immediate notice and its plan for 29
complying with the requirement in paragraph (1) of this subsection. 30
(3) The Commissioner shall establish procedures for a carrier to submit 31
evidence each year that the carrier meets the requirements necessary to qualify for an 32
exemption under paragraph (2) of this subsection. 33
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(4) Notwithstanding the exemption provided in paragraph (2) of this 1
subsection, any carrier that offers a catastrophic plan, as defined by the Affordable Care 2
Act, in the State also must offer at least one catastrophic plan in the Maryland Health 3
Benefit Exchange. 4
(5) Notwithstanding the exemption provided in paragraph (2) of this 5
subsection, the Commissioner, in consultation with the Maryland Health Benefit 6
Exchange: 7
(i) may assess the impact of the exemption provided in paragraph 8
(2) of this subsection and, based on that assessment, alter the limit on the amount of annual 9
premiums that may not be exceeded to qualify for the exemption; and 10
(ii) shall make any change in the exemption requirement by 11
regulation. 12
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 13
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 14
after January 1, 2024. 15
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 16
January 1, 2024. 17