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ROBERT L. EHRLICH, JR., Governor Ch. 409
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(II) ON RENEWAL, A CARRIER MAY ADJUST THE COMMUNITY RATE
FOR A HEALTH BENEFIT PLAN BASED ON CHANCES IN HEALTH STATUS THAT OCCUR
AFTER THE HEALTH BENEFIT PLAN IS ISSUED BY THE CARRIER BY NO MORE THAN
(7) (I) ON RENEWAL, A CARRIER MAY NOT INCREASE THE PREMIUM
RATE BY MORE THAN 25% OF THE RATE THAT WAS CHARGED IN THE PRECEDING
YEAR.
(II) THE LIMITATION IN SUBPARAGRAPH (I) OF THIS PARAGRAPH
MAY NOT INCLUDE ANY PREMIUM RATE INCREASE THAT IS BASED ON A CARRIER'S
ANNUAL COST AND UTILIZATION TRENDS OR CHANGE IN THE RATING FACTOR FOR
ATTAINED ACE FOR COVERED PERSONS.
(b) A carrier shall apply all risk adjustment factors under subsection (a) of this
section consistently with respect to all health benefit plans that are issued, delivered,
or renewed in the State.
[(c) Based on the adjustments allowed under subsection (a)(2) of this section, a
carrier may charge a rate that is 40% above or below the community rate.]
[(d)] (C) (1) A carrier shall base its rating methods and practices on
commonly accepted actuarial assumptions and sound actuarial principles.
(2) A carrier that is a health maintenance organization and that includes
a subrogation provision in its contract as authorized under § 19-713.1(d) of the
Health—General Article shall:
(i) use in its rating methodology an adjustment that reflects the
subrogation; and
(ii) identify in its rate filing with the Administration, and annually
in a form approved by the Commissioner, all amounts recovered through subrogation.
(3) A CARRIER MAY USE HEALTH STATEMENTS, IN A FORM APPROVED
BY THE COMMISSIONER, AND HEALTH SCREENINGS TO ESTABLISH PREMIUM RATES
AS PROVIDED IN THIS SECTION.
(D) A CARRIER MAY NOT LIMIT COVERAGE OFFERED BY THE CARRIER, OR
REFUSE TO ISSUE A HEALTH BENEFIT PLAN TO ANY SMALL EMPLOYER THAT MEETS
THE REQUIREMENTS OF THIS SUBTITLE, BASED ON A HEALTH STATUS RELATED
FACTOR
(E) IT SHALL BE AN UNFAIR TRADE PRACTICE FOR A CARRIER TO KNOWINGLY
PROVIDE COVERAGE TO A SMALL EMPLOYER THAT DISCRIMINATES AGAINST AN
EMPLOYEE OR APPLICANT FOR EMPLOYMENT, BASED ON THE HEALTH STATUS OF
THE EMPLOYEE OR APPLICANT OR A DEPENDENT OF THE EMPLOYEE OR APPLICANT,
WITH RESPECT TO PARTICIPATION IN A HEALTH BENEFIT PLAN SPONSORED BY THE
SMALL EMPLOYER
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- 1903 -
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