Ch. 35

1997 LAWS OF MARYLAND

(1) A CARRIER THAT OFFERS COVERAGE TO A SMALL EMPLOYER

SHALL:

(I) OFFER COVERAGE TO ALL OF ITS ELIGIBLE EMPLOYEES AND
ALL OF THEIR ELIGIBLE DEPENDENTS;

(II) AT THE ELECTION OF THE SMALL EMPLOYER, OFFER
COVERAGE TO ALL OF ITS PART-TIME EMPLOYEES WHO HAVE A NORMAL
WORKWEEK OF AT LEAST 17 1/2 BUT LESS THAN 30 HOURS PER WEEK AND HAVE
BEEN CONTINUOUSLY EMPLOYED FOR AT LEAST 4 CONSECUTIVE MONTHS;

(III) AT THE ELECTION OF THE SMALL EMPLOYER, OFFER
COVERAGE TO ALL OF ITS EMPLOYEES WHO ARE COVERED UNDER ANOTHER
PUBLIC OR PRIVATE PLAN OF HEALTH INSURANCE OR ANOTHER HEALTH BENEFIT
ARRANGEMENT; AND

(IV) ESTABLISH AN ANNUAL OPEN ENROLLMENT PERIOD FOR
SELF-EMPLOYED INDIVIDUALS FOR AT LEAST 30 CONSECUTIVE DAYS IN EACH
6-MONTH PERIOD.

(2) NOTWITHSTANDING ANY OTHER PROVISION OF THIS SECTION AND
§§ 15-1209, 15-1211, AND 15-1213 OF THIS SUBTITLE, A CARRIER MAY DENY COVERAGE
TO A SELF-EMPLOYED INDIVIDUAL WHO APPLIES FOR A HEALTH BENEFIT PLAN AT
A TIME OTHER THAN THE CARRIER'S ANNUAL OPEN ENROLLMENT PERIOD.

(B) HEALTH MAINTENANCE ORGANIZATIONS.

(1) A HEALTH MAINTENANCE ORGANIZATION NEED NOT OFFER
COVERAGE:

(I) TO A SMALL EMPLOYER THAT IS OUTSIDE OF THE HEALTH
MAINTENANCE ORGANIZATION'S APPROVED SERVICE AREAS;

(II) TO AN ELIGIBLE EMPLOYEE WHO RESIDES OUTSIDE OF THE
HEALTH MAINTENANCE ORGANIZATION'S APPROVED SERVICE AREAS; OR

(III) WITHIN AN AREA WHERE THE HEALTH MAINTENANCE
ORGANIZATION REASONABLY ANTICIPATES, AND DEMONSTRATES TO THE
SATISFACTION OF THE COMMISSIONER, THAT IT WILL NOT HAVE THE CAPACITY IN
ITS NETWORK OF PROVIDERS TO DELIVER SERVICE ADEQUATELY BECAUSE OF
OBLIGATIONS TO EXISTING GROUP CONTRACT HOLDERS AND ENROLLEES.

(2) A HEALTH MAINTENANCE ORGANIZATION THAT DOES NOT OFFER
COVERAGE UNDER PARAGRAPH (1)(III) OF THIS SUBSECTION MAY NOT OFFER
COVERAGE IN THE APPLICABLE AREA TO ANY EMPLOYER GROUPS UNTIL THE
LATER OF:

(I) 180 DAYS AFTER A REFUSAL TO DO SO; OR

(II) THE DATE ON WHICH THE HEALTH MAINTENANCE
ORGANIZATION NOTIFIES THE COMMISSIONER THAT IT HAS REGAINED CAPACITY
TO DELIVER SERVICES TO SMALL EMPLOYER GROUPS IN THAT AREA.

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