PARRIS N. GLENDENING, Governor

Ch. 35

(II) SUBPARAGRAPH (I) OF THIS PARAGRAPH DOES NOT APPLY TO
AN INSURANCE PRODUCT THAT:

1. IS LISTED UNDER § 15-1201(F)(3) OF THIS TITLE; OR

2. IS NONRENEWABLE AND HAS A POLICY TERM OF NO
MORE THAN 6 MONTHS.

(III) THE COMMISSIONER MAY ESTABLISH A LOSS RATIO FOR EACH
INSURANCE PRODUCT DESCRIBED IN SUBPARAGRAPH (II)1 AND 2 OF THIS
PARAGRAPH.

(3) THE AUTHORITY OF THE COMMISSIONER UNDER PARAGRAPHS (1)
AND (2) OF THIS SUBSECTION TO REQUIRE AN INSURER, NONPROFIT HEALTH
SERVICE PLAN, OR HEALTH MAINTENANCE ORGANIZATION TO FILE NEW RATES
BASED ON LOSS RATIO:

(I) IS IN ADDITION TO ANY OTHER AUTHORITY OF THE
COMMISSIONER UNDER THIS ARTICLE TO REQUIRE THAT RATES NOT BE
EXCESSIVE, INADEQUATE, OR UNFAIRLY DISCRIMINATORY; AND

(II) DOES NOT LIMIT ANY EXISTING AUTHORITY OF THE
COMMISSIONER TO DETERMINE WHETHER A RATE IS EXCESSIVE.

(4) (I) IN DETERMINING WHETHER TO REQUIRE AN INSURER TO FILE
NEW RATES UNDER THIS SUBSECTION, THE COMMISSIONER MAY CONSIDER THE
AMOUNT OF HEALTH INSURANCE PREMIUMS EARNED IN THE STATE ON
INDIVIDUAL POLICIES IN PROPORTION TO THE TOTAL HEALTH INSURANCE
PREMIUMS EARNED IN THE STATE FOR THE INSURER.

(II) THE INSURER SHALL PROVIDE TO THE COMMISSIONER THE
INFORMATION NECESSARY TO DETERMINE THE PROPORTION OF INDIVIDUAL
HEALTH INSURANCE PREMIUMS TO TOTAL HEALTH INSURANCE PREMIUMS AS
PROVIDED UNDER THIS PARAGRAPH.

(5) THE SECRETARY OF HEALTH AND MENTAL HYGIENE, IN
CONSULTATION WITH THE COMMISSIONER AND IN ACCORDANCE WITH THEIR
MEMORANDUM OF UNDERSTANDING, MAY ADJUST CAPITATION PAYMENTS FOR A
MANAGED CARE ORGANIZATION OR FOR THE MARYLAND MEDICAL ASSISTANCE
PROGRAM OF A MANAGED CARE ORGANIZATION THAT IS A CERTIFIED HEALTH
MAINTENANCE ORGANIZATION:

(I) IF THE LOSS RATIO IS LESS THAN 80% DURING CALENDAR

YEAR 1997; AND

(II) DURING EACH SUBSEQUENT CALENDAR YEAR IF THE LOSS
RATIO IS LESS THAN 85%.

(6) A LOSS RATIO REPORTED UNDER PARAGRAPH (5) OF THIS
SUBSECTION SHALL BE CALCULATED SEPARATELY AND MAY NOT BE PART OF
ANOTHER LOSS RATIO REPORTED UNDER THIS SECTION.

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