[(3) The average community rate for the comprehensive standard health
benefit plan, as determined annually by the Commission, based on the average
community rate submitted by each carrier offering the comprehensive standard health
benefit plan may not exceed 12 percent of Maryland's average annual wage.]

(3)      (1) THE COMMISSION SHALL EXCLUDE OR LIMIT BENEFITS OR
ADJUST COST-SHARING ARRANGEMENTS IN THE COMPREHENSIVE STANDARD
HEALTH BENEFIT PLAN IF THE AVERAGE COMMUNITY RATE FOR THE
COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN, AS DETERMINED ANNUALLY
BY THE COMMISSION BASED ON THE AVERAGE COMMUNITY RATE SUBMITTED BY
EACH CARRIER OFFERING THE COMPREHENSIVE STANDARD HEALTH BENEFIT;
PLAN, EXCEEDS 12 PERCENT OF THIS STATE'S AVERAGE ANNUAL WAGE.

(II) THE COMMISSION MAY REVIEW THE PLAN PERIODICALLY AND
MAY MAKE CHANGES IT DEEMS APPROPRIATE.

(4)      In establishing benefits, the Commission shall judge preventive services,
medical treatments, procedures, and related health services based on:

(i) Their effectiveness in improving the health status of individuals;

(ii) Their impaction maintaining and improving health and on
reducing the unnecessary consumption of health care services; and

(iii) Their impact on the affordability of health care coverage.

(5)     The Commission may exclude any mandated benefit.

(b) The comprehensive standard health benefit plan shall include uniform
deductibles and cost-sharing associated with its benefits, as determined by the
Commission.

(c). In establishing cost-sharing as part of the comprehensive standard health
benefit plan, the Commission shall:

(1)      Include cost-sharing and other incentives to help prevent consumers
from seeking unnecessary services;

(2)      Balance the effect of the cost-sharing in reducing premiums and in
affecting utilization of appropriate services; and

(3)      Limit the total cost-sharing that may be incurred by an individual in a

year.

701.                                               

(b) Notwithstanding subsection (a) of this section, a late enrollee may be subject
to a 12-month preexisting condition provision OR SUBJECT TO AWAITING PERIOD
UNTIL THE NEXT OPEN ENROLLMENT PERIOD NOT TO EXCEED A 12- MONTH PERIOD.

704.                                                                                                                                           

(a) (1) A carrier shall issue its health benefit plans to any small employer that
meets the requirements of this subsection.

Ch. 258

1994 LAWS OF MARYLAND

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