31.11.13.03

.03 Required Notice — Limited Benefit Plan.

A. When a carrier offers the Limited Benefit Plan to a small employer qualified under Insurance Article, §15-1209, Annotated Code of Maryland, and the small employer chooses the Limited Benefit Plan, the carrier shall obtain a signed disclosure statement certifying that:

(1) The small employer was offered the Limited Benefit Plan; and

(2) The small employer received notice that more comprehensive coverage is available under the Comprehensive Standard Health Benefit Plan.

B. The disclosure statement required in §A of this regulation shall be in at least 12-point type and shall read as follows:

MARYLAND HEALTH INSURANCE REFORM ACT LIMITED HEALTH BENEFIT PLAN DISCLOSURE STATEMENT

Limited Health Benefit Plan Disclosure Under Maryland law, a carrier may offer a small employer the Limited Health Benefit Plan. Certain benefits of the Limited Health Benefit Plan are limited to discounts only while other benefits are subject to reduced yearly amounts payable. More comprehensive coverage is available to a small employer under the Comprehensive Standard Health Benefit Plan ("Standard Plan"). Employer Statement I HAVE READ AND UNDERSTAND THE LIMITED HEALTH BENEFIT PLAN DISCLOSURE. I ACKNOWLEDGE THAT I HAVE RECEIVED A DESCRIPTION OF THE LIMITED HEALTH BENEFIT PLAN AND THAT I UNDERSTAND MORE COMPREHENSIVE COVERAGE IS AVAILABLE UNDER THE COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN.
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Carrier Name
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Employer Name
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Producer Name
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Employer Representative Name
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Producer Signature
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Employer Representative Signature
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Date
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Title

C. The carrier shall maintain the signed disclosure statement for not less than 5 years.