PARRIS N. GLENDENING, Governor

Ch. 35

(2) BY AN INSURER OR NONPROFIT HEALTH SERVICE PLAN ON AN
EXPENSE-INCURRED BASIS, SHALL BE ACTUARIALLY EQUIVALENT TO AT LEAST
THE MINIMUM BENEFITS REQUIRED TO BE OFFERED UNDER ITEM (I) OF THIS

SUBSECTION.

(C) EXCLUSIONS, LIMITATIONS, OR ADJUSTMENTS.

(1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION, THE COMMISSION
SHALL EXCLUDE OR LIMIT BENEFITS OR ADJUST COST-SHARING ARRANGEMENTS
IN THE STANDARD PLAN IF THE AVERAGE RATE FOR THE STANDARD PLAN
EXCEEDS 12% OF THE AVERAGE ANNUAL WAGE IN THE STATE.

(2) THE COMMISSION ANNUALLY SHALL DETERMINE THE AVERAGE
RATE FOR THE STANDARD PLAN BY USING THE AVERAGE RATE SUBMITTED BY
EACH CARRIER THAT OFFERS THE STANDARD PLAN.

(D) CRITERIA FOR ESTABLISHING BENEFITS.

IN ESTABLISHING BENEFITS, THE COMMISSION SHALL JUDGE PREVENTIVE
SERVICES, MEDICAL TREATMENTS, PROCEDURES, AND RELATED HEALTH SERVICES
BASED ON:

(1) THEIR EFFECTIVENESS IN IMPROVING THE HEALTH STATUS OF
INDIVIDUALS;

(2) THEIR IMPACT ON MAINTAINING AND IMPROVING HEALTH AND ON
REDUCING THE UNNECESSARY CONSUMPTION OF HEALTH CARE SERVICES; AND

(3) THEIR IMPACT ON THE AFFORDABILITY OF HEALTH CARE
COVERAGE,

(E) EXCLUSION OF MANDATED BENEFITS ALLOWED.
THE COMMISSION MAY EXCLUDE:

(1) A HEALTH CARE SERVICE, BENEFIT, COVERAGE, OR
REIMBURSEMENT FOR COVERED HEALTH CARE SERVICES THAT IS REQUIRED
UNDER THIS ARTICLE OR THE HEALTH - GENERAL ARTICLE TO BE PROVIDED OR
OFFERED IN A HEALTH BENEFIT PLAN THAT IS ISSUED OR DELIVERED IN THE STATE
BY A CARRIER; OR

(2) REIMBURSEMENT REQUIRED BY STATUTE, BY A HEALTH BENEFIT
PLAN FOR A SERVICE WHEN THAT SERVICE IS PERFORMED BY A HEALTH CARE
PROVIDER WHO IS LICENSED UNDER THE HEALTH OCCUPATIONS ARTICLE AND
WHOSE SCOPE OF PRACTICE INCLUDES THAT SERVICE.

(F) DEDUCTIBLES AND COST-SHARING.

THE STANDARD PLAN SHALL INCLUDE UNIFORM DEDUCTIBLES AND
COST-SHARING ASSOCIATED WITH ITS BENEFITS, AS DETERMINED BY THE
COMMISSION.

(G) CONSIDERATIONS FOR COST-SHARING.

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