WILLIAM DONALD SCHAEFER, Governor                        H.B. 1563

(II) FOR THE INITIAL RATE SUBMISSIONS BY CARRIERS AFTER
FORMATION OF EACH REGIONAL HEALTH COOPERATIVE, IF THE COMMUNITY
RATED PREMIUM RATE SUBMITTED BY A CARRIER IS SIGNIFICANTLY ABOVE THE
AVERAGE RATES SUBMITTED BY ALL OTHER CARRIERS IN THAT REGIONAL AREA,
THE REGIONAL HEALTH COOPERATIVE MAY INFORM A CARRIER OF THAT FACT. IF
NOTIFIED BY THE REGIONAL HEALTH COOPERATIVE THAT ITS RATE IS
SIGNIFICANTLY ABOVE THE AVERAGE, THE CARRIER MAY SUBMIT A NEW RATE.

(B) EACH REGIONAL HEALTH COOPERATIVE SHALL ACCEPT CONTRACTS OF
CARRIERS ON OR BEFORE DECEMBER 31, 1995, FOR THE PURPOSE OF PROVIDING
THE HEALTH BENEFIT PLAN TO ELIGIBLE EMPLOYEES AND DEPENDENTS.

(C) A REGIONAL HEALTH COOPERATIVE SHALL ACCEPT CONTRACTS TO
OFFER THE HEALTH BENEFIT PLAN AND SUPPLEMENTAL BENEFITS FROM ALL
CARRIERS THAT MEET THE REQUIREMENTS SET FORTH IN THIS SUBTITLE AND
COMPLY WITH RULES ADOPTED BY THE REGIONAL HEALTH COOPERATIVE AND
ANY REGULATIONS ADOPTED BY THE COMMISSIONER THAT ARE NECESSARY FOR
IMPLEMENTATION OF THIS SUBTITLE.

743. ADDITIONAL REQUIREMENTS FOR CARRIERS.

(A)     IN ADDITION TO ANY OTHER REQUIREMENTS UNDER THIS ARTICLE, A
CARRIER THAT OFFERS THE COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN
AND SUPPLEMENTAL BENEFITS THROUGH A REGIONAL HEALTH COOPERATIVE
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) DESIGN POLICIES TO HELP ENSURE THAT ENROLLEES OR INSUREDS
HAVE ADEQUATE ACCESS TO PROVIDERS OF HEALTH CARE;

(4) PARTICIPATE IN THE PERFORMANCE EVALUATION MEASUREMENT
EFFORTS OF THE HEALTH CARE ACCESS AND COST COMMISSION AND MAKE A
REASONABLE DISCLOSURE OF THE REPORT PROVIDED BY THE HEALTH CARE
ACCESS AND COST COMMISSION IN ITS SOLICITATION AND SALES MATERIALS; AND

(5) IN ITS SOLICITATION AND SALES MATERIALS, DISCLOSE TO THE
REGIONAL HEALTH COOPERATIVE ALL THE ADDITIONAL BENEFITS THAT IT OFFERS
IN THAT REGIONAL AREA BOTH THROUGH THE REGIONAL HEALTH COOPERATIVE
AND OUTSIDE THE REGIONAL HEALTH COOPERATIVE.

(B)     PARTICIPATING CARRIERS SHALL OFFER CONTRACTS SEPARATELY FOR
EACH REGIONAL AREA.

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