PARRIS N. GLENDENING, Governor

Ch. 294

15-1306.

(A) A CARRIER THAT INTENDS TO OFFER TWO POLICY FORMS SHALL SUBMIT
IN WRITING TO THE COMMISSIONER BOTH:

(1) AN ELECTION WHETHER TO OFFER:

(I) A HIGH LEVEL AND LOW LEVEL POLICY FORM, EACH OF
WHICH INCLUDES BENEFITS SUBSTANTIALLY SIMILAR TO OTHER INDIVIDUAL
HEALTH INSURANCE COVERAGE OFFERED BY THE CARRIER IN THIS STATE; OR

(II) POLICY FORMS WITH THE LARGEST AND NEXT TO LARGEST
PREMIUM VOLUME OF ALL POLICY FORMS OFFERED BY THE CARRIER IN THIS
STATE; AND

(2) AN ELECTION WHETHER TO USE THE WEIGHTED AVERAGE
VALUATION DESCRIBED IN § 15-1301(T)(1)(I) OR (II) OF THIS SUBTITLE.

(B) (1) AN ELECTION MADE UNDER THIS SECTION SHALL BE BINDING FOR
A 2-YEAR PERIOD.

(2) AFTER THE INITIAL 2-YEAR PERIOD, AND FOR EACH SUBSEQUENT
2-YEAR PERIOD, CARRIERS SHALL AGAIN MAKE THE ELECTIONS REQUIRED BY THIS
SECTION.

(3) AN ELECTION SHALL BE MADE ON A FORM AND IN A MANNER
REQUIRED BY THE COMMISSIONER.

15-1307.

(A) THE ACTUARIAL VALUE OF BENEFITS PROVIDED UNDER INDIVIDUAL
HEALTH INSURANCE COVERAGE SHALL BE CALCULATED BASED ON A
STANDARDIZED POPULATION AND A SET OF STANDARDIZED UTILIZATION AND
COST FACTORS.

(B) A CARRIER SHALL SUBMIT ANY INFORMATION THE COMMISSIONER MAY
REQUIRE TO SUPPORT AND JUSTIFY THE CARRIER'S CALCULATIONS OF ACTUARIAL
VALUES.

15-1308.

(A) SUBJECT TO SUBSECTIONS (C) AND (G) OF THIS SECTION, A CARRIER
SHALL ISSUE THE INDIVIDUAL HEALTH BENEFIT PLAN ELECTED UNDER § 15-1305 OR
§ 15-1306(A)(1) OF THIS SUBTITLE TO ANY ELIGIBLE INDIVIDUAL

(B) (1) A CARRIER MAY NOT LIMIT COVERAGE UNDER ANY INDIVIDUAL
HEALTH BENEFIT PLAN ISSUED TO AN ELIGIBLE INDIVIDUAL UNDER A
PREEXISTING CONDITION PROVISION.

(2) A CARRIER MAY IMPOSE A PREEXISTING CONDITION PROVISION ON
AN INDIVIDUAL WHO HAS HAD A PERIOD OF AT LEAST 63 DAYS DURING ALL OF
WHICH THE INDIVIDUAL WAS NOT COVERED UNDER ANY CREDITABLE COVERAGE
AND WHO WOULD OTHERWISE HAVE BEEN AN ELIGIBLE INDIVIDUAL

- 2171 -