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31.17.03.00.htm 31.17.03.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 17 MARYLAND HEALTH INSURANCE PLAN Chapter 03 Operation and Administration of the Plan Authority: Insurance Article, §14-503(k) Annotated Code of Maryland
31.17.03.01.htm 31.17.03.01. 01 Purpose.. The purpose of this chapter is to describe how the Board of Directors of the Maryland Health Insurance Plan shall operate and administer the Maryland Health Insurance Plan.
31.17.03.02.htm 31.17.03.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Administrator" means:. a) A person that is registered as an administrator under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland; orb) A carrier.. 2) "Board" means the Board of Directors for the Maryland Health Insurance Plan.. 3) "Carrier" means:. a) An authorized insurer that provides health insurance in the State;.
31.17.03.03.htm 31.17.03.03. 03 Board Meetings.. A. The Board shall meet at the times and places and with the frequency that the Board considers appropriate to conduct the business of the Plan.B. The Board shall adopt through bylaws the procedures for providing notice of Board meetings..
31.17.03.04.htm 31.17.03.04. 04 Executive Director.. A. The Board shall appoint an Executive Director who shall be the chief administrative officer of the Plan.B. The Executive Director shall serve at the pleasure of the Board.. C. Under the direction of the Board, the Executive Director shall perform any duty or function that is necessary for the operation of the Plan.
31.17.03.05.htm 31.17.03.05. 05 Independent Consultants.. A. The Board may contract with independent consultants to perform any function that the Board assigns to the consultants, including actuarial analysis and financial analysis.B. Unless permission is granted specifically by the Board, an independent consultant that contracts with the Board may not release, publish, or otherwise use any information to which the independent consultant had access under its contract with the Board.
31.17.03.06.htm 31.17.03.06. 06 Plan Administrator.. A. The Board shall select a Plan administrator.. B. The Board may select more than one Plan administrator, if the Board decides to contract with different administrators to administer:1) Different standard benefit packages;. 2) Specific benefits, such as a prescription drug benefit; or. 3) Specific administrative functions of the Plan, such as case management.. C. Each Plan administrator shall serve for a period of time specified in it
31.17.03.07.htm 31.17.03.07. 07 Hospital Assessments.. A. Each year, the Commission shall calculate the monthly Plan assessment that each hospital shall pay to the Fund.B. The Commission shall send a billing notice to each hospital for its Plan assessment.. C. Beginning April 1, 2003, each hospital shall forward its monthly Plan assessment to the Fund.. D. Any failure by a hospital to pay the required Plan assessment shall be monitored by the Board, or its designee, and reported to the Commission.
31.17.03.08.htm 31.17.03.08. 08 Investment of Fund Assets.. The assets of the Fund shall be invested in the State Treasurer's interest allocation program, which shall provide interest to the Fund at the rate the State's General Fund earns interest on its investments.
31.17.03.09.htm 31.17.03.09. 09 Determination of Plan Benefits and Plan Structure.. A. The Board shall establish at least two standard benefit packages to be offered by the Plan.. B. The Board may choose to establish the standard benefit packages with the only difference between each standard benefit package being in the area of the cost-sharing requirements.C. The standard benefit packages established by the Board shall be described in the contract between the Plan administrator and the Board and shall in
31.17.03.10.htm 31.17.03.10. 10 Determination of Plan Premium.. A. The Board shall establish a premium rate for each standard benefit package in the Plan.. B. The Board may contract with an actuary to establish the premium rate for each standard benefit package in the Plan.C. Standard Risk Rate.. 1) The Board shall establish a standard risk rate premium rate for each standard benefit package in the Plan.2) The standard risk rate for each standard benefit package in the Plan shall be developed by consid
31.17.03.10-1.htm 31.17.03.10-1. 10-1 Low-Income Subsidy.. A. The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:1) Is enrolled, or eligible to enroll, in the Plan;. 2) Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;3) Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and4) Provides to the plan a
31.17.03.11.htm 31.17.03.11. 11 Evaluation of Plan.. The Board shall annually evaluate the Plan to assure that Plan enrollment does not exceed the number of members the Plan has the financial capacity to insure.
31.17.03.12.htm 31.17.03.12. 12 Marketing of Plan.. A. The Board shall establish and maintain public awareness of the Plan, including its eligibility requirements and enrollment procedures.B. The methods to be used by the Board to establish and maintain public awareness of the Plan shall include, but are not limited to:1) Establishing a mailing list of interested persons, advocacy groups, carriers, and potential applicants to the Plan for the purpose of notifying them of the availability of
31.17.03.13.htm 31.17.03.13. 13 Certificates of Coverage.. A. The Plan administrator shall issue certificates of coverage to individuals covered under the Plan that describe the essential features of the Plan including:1) Benefits;. 2) Exclusions and limitations;. 3) Cost-sharing requirements;. 4) Any annual or lifetime maximums;. 5) Termination provisions; and. 6) Any utilization review or precertification requirements.. B. If dependents are included in the coverage, only one certificate shall b
31.17.03.14.htm 31.17.03.14. 14 Eligibility Requirements.. A. Except as provided in §D―F of this regulation, an individual is eligible for coverage under the Plan if the individual is:1) A medically uninsurable individual; and. 2) Satisfies any applicable residency requirement in §C of this regulation.. B. Eligibility for Employer-Sponsored Group Health Insurance Plan.. 1) For purposes of determining whether an individual who is eligible for coverage under an employer-sponsored group health in
31.17.03.15.htm 31.17.03.15. 15 Plan Enrollment Procedures.. A. The Board or the Plan administrator, acting on behalf of the Board, shall accept and process applications from individuals for enrollment in the Plan.B. Except as provided in §C of this regulation, an individual may apply for coverage under the Plan throughout each year.C. If an individual's eligibility is based on the individual's prior denial of coverage by a carrier, the individual may only apply for Plan coverage within 6 months of the re
31.17.03.16.htm 31.17.03.16. 16 Preexisting Condition Limitations.. A. The Board may implement a preexisting condition exclusion for the Plan, which shall be described in the Board's contract with the Plan administrator.B. If the Board implements a preexisting condition exclusion for the Plan, the preexisting condition exclusion may not apply to:1) An eligible individual under the Maryland Health Insurance Portability and Accountability Act as defined in Insurance Article, §15-1301, Annotated
31.17.03.17.htm 31.17.03.17. 17 Termination of Coverage.. A. Termination of Plan Coverage for Nonpayment of Premium. A member's coverage automatically terminates at the end of the grace period if a premium is not received before the end of the grace period.B. Termination of Plan Coverage for Specified Causes.. 1) A member's coverage under the Plan terminates at the end of the month in which any of the following occur:a) For a dependent child, other than a child who is unable to self support
31.17.03.18.htm 31.17.03.18. 18 Coordination of Benefits With Other Coverage.. If a member has other health care coverage, the Plan administrator shall coordinate benefits with that other health care coverage in accordance with the terms described in the Plan administrator's contract with the Board.
31.17.03.19.htm 31.17.03.19. 19 Complaints.. A. The Plan administrator shall comply with the complaint process for adverse decisions and grievance decisions in Insurance Article, Title 15, Subtitle 10A, Annotated Code of Maryland.B. The Plan administrator shall comply with the complaint process for coverage decisions in Insurance Article, Title 15, Subtitle 10D, Annotated Code of Maryland.C. Members and providers shall have the same appeal rights regarding denials under the Plan as found
31.17.03.9999.htm 31.17.03.9999. Administrative History Effective date:. Regulations .01―19 adopted as an emergency provision effective April 8, 2003 (30:9 Md. R. 609) emergency text amended effective July 1, 2003 (30:16 Md. R. 1072) adopted permanently effective December 22, 2003 (30:25 Md. R. 1851)Regulation .01B amended effective May 21, 2007 (34:10 Md. R. 891). Regulation .02B amended effective February 22, 2010 (37:4 Md. R. 343) August 9, 2010 (37:16 Md. R. 1060) January 7, 2013 (39:26 Md. R. 1666)
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