ROBERT L. EHRLICH, JR., Governor                             Ch. 203

(4) "MCHP PREMIUM PLAN" MEANS THE PLAN ESTABLISHED UNDER
THIS SECTION TO PROVIDE ACCESS TO HEALTH INSURANCE COVERAGE TO ELIGIBLE
INDIVIDUALS THROUGH MANAGED CARE ORGANIZATIONS UNDER THE MARYLAND
CHILDREN'S HEALTH PROGRAM.

(b) This EXCEPT AS PROVIDED IN SUBSECTION (C) OF THIS SECTION, THIS
section applies only to individuals whose family income is above 200 percent, but at or
below 300 percent of the federal poverty guidelines.

[(c)(1) An eligible individual who is enrolled in the MCHP private option
plan shall be insured through an employer's health benefit plan if:

(i) The employer offers family health insurance coverage to the
parent or guardian of an eligible individual;

(ii) The employer elects to participate in the MCHP private option
plan;

(iii) The parent or guardian of an eligible individual is insured
under the employer-sponsored health benefit plan;

(iv) The employer contributes to family health insurance coverage
at a rate no less than 30 percent of annual premiums;

(v) The plan includes a benefit package that is determined by the
Department to be at least equivalent to the Comprehensive Standard Health Benefit
Plan established under § 15-1207 of the Insurance Article; and

(vi) The plan does not impose cost sharing requirements on eligible
individuals.

(2) (i) The State's cost for coverage of an eligible individual enrolled in
the MCHP private option plan may not be greater than the cost of coverage if the
eligible individual was insured through a managed care organization as defined in §
15-101(f) of this title.

(ii) If an employer-sponsored health benefit plan that meets the
criteria under paragraph (1) of this subsection is not available to the eligible
individual or if the Department determines that the employer-sponsored health
benefit plan is not cost effective as required in item (i) of this paragraph, the eligible
individual shall be insured through a managed care organization as defined in §
15-101(f) of this title.

(d) The Department shall facilitate coverage of eligible individuals under an
employer-sponsored health benefit plan by:

(1)     Evaluating employer-sponsored health benefit plans to determine
whether specific plans meet applicable State and federal requirements;

(2)     Assisting employers that wish to participate in the MCHP private
option plan to meet the eligibility criteria established under subsection (c) of this
section;

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