ROBERT L. EHRLICH, JR., Governor

Ch. 94

(II) BASED ON THE ADJUSTMENT FOR ACE ALLOWED UNDER
PARAGRAPH (2)(I) OF THIS SUBSECTION, A CARRIER MAY CHARGE A RATE THAT IS 60%
ABOVE OR BELOW THE COMMUNITY RATE.

(5) (I) BASED ON THE ADJUSTMENT FOR HEALTH STATUS ALLOWED
UNDER PARAGRAPH (2)(III) OF THIS SUBSECTION, A CARRIER MAY CHARGE A RATE
THAT IS 25% ABOVE OR BELOW THE COMMUNITY RATE.

(II) A CARRIER MAY NOT ADJUST THE COMMUNITY RATE FOR A
HEALTH BENEFIT PLAN BASED ON CHANGES IN HEALTH STATUS THAT OCCUR
AFTER THE HEALTH BENEFIT PLAN IS ISSUED BY THE CARRIER.

(6) BASED ON THE ADJUSTMENT FOR TOBACCO USE ALLOWED IN
PARAGRAPH (2)(IV) OF THIS SUBSECTION, A CARRIER MAY CHARGE A RATE THAT IS
25% ABOVE OR BELOW THE COMMUNITY RATE.

(b) A carrier shall apply all risk adjustment factors under subsection (a) of this
section consistently with respect to all health benefit plans that are issued, delivered,
or renewed in the State.

[(e) Based on the adjustments allowed under subsection (a)(2) of this section, a
carrier may charge a rate that is 40% above or below the community rate.]

[(d)] (C)(1) A carrier shall base its rating methods and practices on
commonly accepted actuarial assumptions and sound actuarial principles.

(2) A carrier that is a health maintenance organization and that includes
a subrogation provision in its contract as authorized under § 19-713.1(d) of the
Health—General Article shall:

(i) use in its rating methodology an adjustment that reflects the
subrogation; and

(ii) identify in its rate filing with the Administration, and annually
in a form approved by the Commissioner, all amounts recovered through subrogation.

(3) A CARRIER MAY USE STANDARDIZED HEALTH STATEMENTS, IN A
FORM ADOPTED BY THE COMMISSIONER, HEALTH SCREENINGS, AND PRIOR CLAIMS
HISTORY TO ESTABLISH OR MODIFY PREMIUM RATES AS PROVIDED IN THIS SECTION.

(D) A CARRIER MAY NOT LIMIT COVERAGE OFFERED BY THE CARRIER, OR
REFUSE TO ISSUE A HEALTH BENEFIT PLAN TO ANY SMALL EMPLOYER THAT MEETS
THE REQUIREMENTS OF THIS SUBTITLE, BASED ON A HEALTH STATUS RELATED
FACTOR

(E) A CARRIER MAY NOT KNOWINGLY PROVIDE COVERAGE TO A SMALL
EMPLOYER THAT DISCRIMINATES AGAINST AN EMPLOYEE OR APPLICANT FOR
EMPLOYMENT, BASED ON THE HEALTH STATUS OF THE EMPLOYEE OR APPLICANT
OR A DEPENDENT OF THE EMPLOYEE OR APPLICANT, WITH RESPECT TO
PARTICIPATION IN A HEALTH BENEFIT PLAN SPONSORED BY THE SMALL EMPLOYER

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