Ch. 287                                    2004 LAWS OF MARYLAND

(5) REASONABLE COVERAGE OF OBSTETRICAL CARE, INCLUDING
SERVICES BY A LICENSED HEALTH CARE PROVIDER, DELIVERY ROOM, POSTPARTUM
CARE, AND OTHER MEDICALLY NECESSARY HOSPITAL SERVICES; AND

(6) REASONABLE COVERAGE OF MEDICALLY NECESSARY EMERGENCY
SERVICES.

[(c)](D) (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 10% 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)](E) In establishing benefits UNDER THE STANDARD PLAN AND THE
LIMITED BENEFIT PLAN, 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)](F) The Commission may exclude FROM THE STANDARD PLAN OR THE
LIMITED BENEFIT PLAN:

(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)] (G) The Standard Plan AND THE LIMITED BENEFIT PLAN EACH shall
include uniform deductibles and cost-sharing associated with its benefits, as
determined by the Commission.

[(g)](H) In establishing cost-sharing as part of the Standard Plan AND THE
LIMITED BENEFIT PLAN, the Commission shall:

(1)     include cost-sharing and other incentives to help prevent consumers
from seeking unnecessary services;

(2)     balance the effect of cost-sharing in reducing premiums and in
affecting utilization of appropriate services; and

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