Maryland § 15-1A-09

§ 15-1A-09.

    (a)    Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article:

        (1)    Subtitle 4 of this title;

        (2)    §§ 15–1206(c), 15–1208.1, 15–1208.2, 15–1209, and 15–1210 of this title;

        (3)    §§ 15–1316 and 15–1318 of this title; and

        (4)    §§ 15–1406 and 15–1406.1 of this title.

    (b)    (1)    Except as provided in paragraph (2) of this subsection, a carrier may restrict enrollment to open or special enrollment periods.

        (2)    A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year.

    (c)    If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier:

        (1)    (i)    may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and

            (ii)    if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or

        (2)    may deny coverage within a service area if the carrier:

            (i)    demonstrates to the Commissioner that:

                1.    the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and

                2.    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and

            (ii)    does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area.

    (d)    A carrier may deny coverage if the carrier:

        (1)    demonstrates to the Commissioner that:

            (i)    the carrier does not have the financial reserves necessary to underwrite additional coverage; and

            (ii)    the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status–related factor; and

        (2)    unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.