WILLIAM DONALD SCHAEFER, Governor

H.B. 1563

(2) TO BE COVERED UNDER THE HEALTH BENEFIT PLAN OFFERED BY A
CARRIER, A GROUP OR INDIVIDUAL SHALL:

(I) ELECT TO BE COVERED UNDER THE PLAN;

(II) AGREE TO MAKE THE REQUIRED PREMIUM PAYMENTS; AND

(III) SATISFY THE OTHER REASONABLE PROVISIONS OF THE PLAN
AS APPROVED BY THE COMMISSIONER.

(3)      ANY REQUIREMENT USED BY A CARRIER IN DETERMINING
WHETHER TO PROVIDE COVERAGE TO A GROUP, INCLUDING REQUIREMENTS FOR
MINIMUM PARTICIPATION OF THE GROUP, SHALL BE APPLIED UNIFORMLY AMONG
ALL GROUPS WITH THE SAME NUMBER OF MEMBERS APPLYING FOR COVERAGE OR
RECEIVING COVERAGE FROM THE CARRIER.

(4)      (I) A CARRIER MAY NOT APPLY MINIMUM PARTICIPATION
REQUIREMENTS TO HEALTH BENEFIT PLANS OFFERED THROUGH THE REGIONAL
HEALTH COOPERATIVE.

(II) OUTSIDE A REGIONAL HEALTH COOPERATIVE A CARRIER
MAY ONLY VARY APPLICATION OF MINIMUM PARTICIPATION OF GROUP MEMBERS
BY THE SIZE OF THE GROUP.

(5)      A CARRIER MAY NOT REQUIRE MINIMUM EMPLOYER

CONTRIBUTIONS.

(6)      ANY SUPPLEMENTAL BENEFITS SHALL BE SUBJECT TO THE SAME
REQUIREMENTS AS THE COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN
CONCERNING!

(I) GUARANTEED ISSUANCE;

(II) GUARANTEED RENEWAL;

(III) ADJUSTED COMMUNITY RATING;

(IV)   THE PROHIBITION ON PREEXISTING CONDITION LIMITATIONS;
AND

(V)     ANY OTHER PROVISIONS THE COMMISSIONER DETERMINES
ARE NECESSARY TO ACHIEVE THE PURPOSES OF THIS SUBTITLE.

(B) (1) A HEALTH MAINTENANCE ORGANIZATION THAT IS A

PARTICIPATING CARRIER SHALL OFFER HEALTH BENEFIT PLANS TO ENROLLEES
THROUGHOUT A REGIONAL AREA UNLESS GRANTED A SPECIFIC EXCEPTION BY THE
COMMISSIONER IN CONSULTATION WITH THE REGIONAL HEALTH COOPERATIVE.

(2) IF THE PARTICIPATING CARRIER PROVIDES SERVICE OR COVERAGE
IN ANY PORTION OF A COUNTY WITHIN A REGIONAL AREA, IT SHALL PROVIDE
SERVICE OR COVERAGE IN THAT ENTIRE COUNTY.

(3) A HEALTH MAINTENANCE ORGANIZATION SHALL OFFER HEALTH
BENEFIT PLANS TO ENROLLEES THROUGHOUT ITS ENTIRE SERVICE AREA.

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