WILLIAM DONALD SCHAEFER, Governor                        H.B. 1563

(3) REPEATED MISUSE OF A PROVIDER NETWORK PROVISION
INCLUDING UNREASONABLE REFUSAL OF THE ENROLLEE TO FOLLOW A
PRESCRIBED COURSE OF TREATMENT, ABUSIVE OVERUTILIZATION BY AN
ENROLLEE, OR VIOLATION OF REASONABLE POLICIES OF A CARRIER;

(4) NONCOMPLIANCE BY THE ENROLLEE'S EMPLOYER WITH THE
MINIMUM PARTICIPATION REQUIREMENTS:

(I) ESTABLISHED BY THE REGIONAL HEALTH COOPERATIVE
UNDER § 739 OF THIS SUBTITLE FOR HEALTH BENEFIT PLANS OFFERED THROUGH
THE REGIONAL HEALTH COOPERATIVE; OR

(II) ESTABLISHED BY THE CARRIER UNDER § 752 OF THIS SUBTITLE
FOR HEALTH BENEFIT PLANS OFFERED OUTSIDE THE REGIONAL HEALTH
COOPERATIVE; OR

(5) THE CARRIER ELECTS TO TERMINATE ALL HEALTH BENEFIT PLANS
OFFERED THROUGH THE REGIONAL HEALTH COOPERATIVE IN ANY ONE OF THE
FOLLOWING MARKET GROUPS:

(I) THE INDIVIDUAL MARKET;

(II) EMPLOYEES OF EMPLOYERS THAT EMPLOY AT LEAST TWO BUT
NOT MORE THAN 50 EMPLOYEES; OR

(III) EMPLOYEES OF EMPLOYERS THAT EMPLOY MORE THAN 50
EMPLOYEES.

(B) (1) A CARRIER THAT ELECTS NOT TO RENEW HEALTH BENEFIT PLANS
OFFERED IN A PARTICULAR REGIONAL AREA THROUGH A REGIONAL HEALTH
COOPERATIVE SHALL:

(I) PROVIDE ADVANCE NOTICE OF ITS DECISION UNDER THIS
PARAGRAPH TO THE AFFECTED REGIONAL HEALTH COOPERATIVE AND THE
INSURANCE COMMISSIONER; AND

(II) PROVIDE NOTICE OF THE DECISION TO ENROLLEES AT LEAST
120 DAYS PRIOR TO THE NONRENEWAL OF ANY HEALTH BENEFIT PLAN BY THE
CARRIER.

(2) THE PARTICIPATING CARRIER SHALL BE PROHIBITED FROM
WRITING NEW BUSINESS WITH THAT REGIONAL HEALTH COOPERATIVE FOR A
PERIOD OF 5 YEARS FROM THE DATE OF NOTICE TO THE REGIONAL HEALTH
COOPERATIVE OR UNTIL THE REGIONAL HEALTH COOPERATIVE INVITES THE
CARRIER TO RENEW PARTICIPATION, WHICHEVER IS SOONER.

(3) IN A PARTICULAR REGIONAL AREA, A CARRIER MAY NOT RENEW
HEALTH BENEFIT PLANS THAT ARE OFFERED OUTSIDE THE REGIONAL HEALTH
COOPERATIVE IF THE CARRIER ELECTS NOT TO RENEW HEALTH BENEFIT PLANS
OFFERED THROUGH THE REGIONAL HEALTH COOPERATIVE.

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