PARRIS N. GLENDENING, Governor

Ch. 35

on the type of minimum participation requirement that a carrier may impose,
see § 15-1206(c) of this subtitle.

Defined terms: "Carrier" § 15-1201
"Eligible employee" § 15-1201
"Health insurance" § 1-101
"Person" § 1-101
"Small employer" § 15-1201

15-1204. REQUIREMENTS AND LIMITATIONS FOR CARRIERS.

(A) IN GENERAL.

IN ADDITION TO ANY OTHER REQUIREMENT UNDER THIS ARTICLE, A
CARRIER SHALL:

(1) HAVE DEMONSTRATED THE CAPACITY TO ADMINISTER THE
HEALTH BENEFIT PLAN, INCLUDING ADEQUATE NUMBERS AND TYPES - OF
ADMINISTRATIVE PERSONNEL;

(2) HAVE A SATISFACTORY GRIEVANCE PROCEDURE AND ABILITY TO
RESPOND TO ENROLLEES' CALLS, QUESTIONS, AND COMPLAINTS;

(3) PROVIDE, IN THE CASE OF INDIVIDUALS COVERED UNDER MORE
THAN ONE HEALTH BENEFIT PLAN, FOR COORDINATION OF COVERAGE UNDER ALL
OF THOSE HEALTH BENEFIT PLANS IN AN EQUITABLE MANNER; AND

(4) DESIGN POLICIES TO HELP ENSURE ADEQUATE ACCESS TO
PROVIDERS OF HEALTH CARE.

(B) STANDARD PLAN REQUIRED.

A PERSON MAY NOT OFFER A HEALTH BENEFIT PLAN IN THE STATE UNLESS
THE PERSON OFFERS AT LEAST THE STANDARD PLAN.

(C) LESS THAN MINIMUM COVERAGE PROHIBITED.

A CARRIER MAY NOT OFFER A HEALTH BENEFIT PLAN THAT HAS FEWER
BENEFITS THAN THOSE IN THE STANDARD PLAN.

(D) OPTIONAL ADDITIONAL COVERAGE.

A CARRIER MAY OFFER BENEFITS IN ADDITION TO THOSE IN THE STANDARD
PLAN IF THE ADDITIONAL BENEFITS:

(1) ARE OFFERED AND PRICED SEPARATELY FROM BENEFITS
SPECIFIED IN ACCORDANCE WITH § 15-1207 OF THIS SUBTITLE; AND

(2) DO NOT HAVE THE EFFECT OF DUPLICATING ANY OF THOSE

BENEFITS.

(E) POINT OF SERVICE DELIVERY SYSTEM.

NOTWITHSTANDING SUBSECTION (B) OF THIS SECTION, A HEALTH
MAINTENANCE ORGANIZATION MAY PROVIDE A POINT OF SERVICE DELIVERY

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