WILLIAM DONALD SCHAEFER, Governor                                Ch. 9

STATE. UNTIL SEPTEMBER 30, 1996 JANUARY 1, 1995 CARRIERS WHO DO NOT IMPOSE
PREEXISTING CONDITION LIMITATIONS MAY REQUIRE THAT A SMALL EMPLOYER
HAVE AT LEAST THREE ELIGIBLE EMPLOYEES.

(2) IF THE FEDERAL EMPLOYEE RETIREMENT INCOME SECURITY ACT
IS AMENDED TO EXCLUDE EMPLOYEE GROUPS UNDER A SPECIFIC SIZE,
NOTWITHSTANDING PARAGRAPH (1) OF THIS SUBSECTION, THIS SUBTITLE SHALL
APPLY TO ANY EMPLOYEE GROUP SIZE THAT IS EXCLUDED FROM THAT FEDERAL
ACT.

(3) IN DETERMINING THE NUMBER OF ELIGIBLE EMPLOYEES,
COMPANIES WHICH ARE AFFILIATED COMPANIES OR WHICH ARE ELIGIBLE TO FILE
A COMBINED STATE CONSOLIDATED FEDERAL INCOME TAX RETURN SHALL BE
CONSIDERED ONE EMPLOYER.

698A.

EXCEPT AS PROVIDED IN § 706 712 OF THIS SUBTITLE, THIS SUBTITLE APPLIES
ONLY TO CARRIERS THAT OFFER HEALTH BENEFIT PLANS COVERING ELIGIBLE
EMPLOYEES OF SMALL EMPLOYERS.

699.

(A) IN ADDITION TO ANY OTHER REQUIREMENTS UNDER THIS ARTICLE, A
CARRIER THAT OFFERS A HEALTH BENEFIT PLAN IN THE STATE SHALL:

(1) HAVE DEMONSTRATED THE CAPACITY TO ADMINISTER THE
HEALTH BENEFIT PLAN, INCLUDING ADEQUATE NUMBERS AND TYPES OF
ADMINISTRATIVE STAFF;

(2) HAVE A SATISFACTORY GRIEVANCE PROCEDURE AND ABILITY TO
RESPOND TO ENROLLEES' CALLS, QUESTIONS, AND COMPLAINTS;

(3) PROVIDE, IN THE CASE OF INDIVIDUALS COVERED UNDER MORE
THAN ONE HEALTH BENEFIT PLAN, FOR COORDINATION OF COVERAGE UNDER ALL
OF THOSE PLANS IN AN EQUITABLE MANNER; AND

(4) DESIGN POLICIES TO HELP ENSURE THAT ENROLLEES OR INSUREDS
HAVE ADEQUATE ACCESS TO PROVIDERS OF HEALTH CARE.

(B) (1) A CARRIER MAY NOT OFFER ANY HEALTH BENEFIT PLAN IN THE
STATE UNLESS THE CARRIER OFFERS AT LEAST THE COMPREHENSIVE STANDARD
HEALTH BENEFIT PLAN SPECIFIED BY THE COMMISSION UNDER § 700 OF THIS
SUBTITLE.

(2) BENEFITS IN ADDITION TO THE COMPREHENSIVE STANDARD
HEALTH BENEFIT PLAN MAY BE OFFERED IF THE ADDITIONAL BENEFITS:

(I) ARE OFFERED AND PRICED SEPARATELY FROM BENEFITS
SPECIFIED IN ACCORDANCE WITH § 700 OF THIS SUBTITLE; AND

(II) DO NOT HAVE THE EFFECT OF DUPLICATING ANY OF THOSE
BENEFITS.

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