This bulletin is
meant to place insurers authorized to write insurance in Maryland on notice of the
insurance laws (Insurance Article § 1-101 et seq., Annotated
Code of Maryland) passed by the 2003 Maryland General Assembly. The attached
synopsis is intended to serve only as a guide. All
insurers should refer to the 2003 Chapter Laws of Maryland for complete drafts of the law. Insurers are advised that other bills passed by
the General Assembly and not listed on the synopsis may also affect their business
operations in Maryland.
For a copy of a
specific law passed by the General Assembly during the 2003 legislative session, you may
obtain a copy of the bill on the Internet at http://mlis.state.md.us or contact the Department of Legislative Services at (410) 946-5400.
In addition, you may also obtain a copy of the 2003 Session Review from
Library and Information Services, Office of Policy Analysis, Department of Legislative
Services, 90 State Circle, Annapolis, Maryland 21401-1991
or call (410) 946-5400.
For additional
information concerning the Maryland Insurance Administration's Summary of Legislation,
please contact Kathleen Loughran, Director of Government Affairs, at (410) 468-2014.
· Requires the Secretary of the Department of Health and Mental
Hygiene to develop a program that will provide information to ineligible Maryland Pharmacy
Assistance Program applicants regarding the programs they may be eligible for, including
the Senior Prescription Drug Program established under Title 14, Subtitle 5 of the
Insurance Article.
Effective
date: July 1, 2003
· Establishes that the Short-Term Prescription Drug Subsidy Plan
shall provide benefits to the maximum number of individuals eligible for enrollment in the
program.
· Eliminates the cap that limits the program to 30,000 enrollees.
Effective date: April 8, 2003
· Establishes § 15-1601 of the Insurance Article for the purpose
of allowing recipients of a Community Access Program grant from the United States
Department of Health and Human Services to establish a pilot program to coordinate health
care provider reimbursements in order to test innovations in payment for health care
services to be permanently implemented if successful.
· Establishes certain requirements for the pilot program.
· Establishes that a pilot program created under § 15-1601:
(1) Is not providing insurance as defined in § 1-101 of
the Insurance Article;
(2) Is
not subject to regulation by the Maryland Insurance Commissioner;
(3) Shall
not be considered an unauthorized insurer as defined in § 1-101 of
· A pilot program created under § 15-1601 of the Insurance
Article shall report to the Senate Finance Committee and House Health and Government
Operations Committee on or before June of each year.
Effective date: July 1, 2003
for a period of two years
· Requires the Insurance Commissioner to conduct an examination,
at least once every three years, of any pharmacy benefit manager registered as a private
review agent to determine whether the pharmacy benefit manager is acting in compliance
with § 15-10B of the Insurance Article.
· Requires the Insurance Commissioner to make a complete report
of each examination of a pharmacy benefit manager conducted under § 15-10B-20 of the
Insurance Article.
· Requires a pharmacy benefit manager subject to an examination
under
· Establishes that a final report of an examination of a pharmacy
benefit manager will be issued in accordance with § 2-209 of the Insurance Article.
Effective date: October 1, 2003
· Requires a carrier that offers a Medicare supplement policy C
or a Medicare supplement policy I to make those policies available to an individual who is
under the age of 65 years but is eligible for Medicare due to a disability during the
6-month period following the applicant's enrollment in Part B of Medicare.
Effective
date: July 1, 2003
· Defines "Disability Benefit" to mean a benefit that
is payable based on the disability of a covered individual.
· Disability benefit does not include:
(1)
Long-term care insurance;
(2)
A benefit that is payable based solely on a dismemberment
of a covered individual;
(3) Benefits in a life insurance policy that operate to safeguard the contract from lapse or to provide a special surrender value, special benefit, or annuity in the event of total and permanent disability; o
(4)
Benefits in a health insurance policy that operate to
safeguard the contract from lapse due to disability.
· Defines "adverse benefit determination" to mean:
(1)
A denial, reduction, or termination of a disability
benefit;
(2)
A failure to provide or make payment, in whole or in part,
for a disability benefit; or
(3)
Any denial, reduction, termination, or failure to provide
or make payment that is based on a determination of an individual's eligibility for
coverage of a disability benefit.
· Requires the Insurance Commissioner to adopt regulations that
establish standards governing the processing of claims by an insurer that issues or
delivers:
(1) Individual
policies in the State that include a disability benefit, or
(2) Group policies
in the State that include a disability benefit.
· The regulations adopted under this law shall establish and
maintain reasonable claims procedures governing the filing of disability benefit claims.
· Requires the claims procedures established under this law for
individual policies and group policies to be consistent with the provisions of the
Department of Labor's regulations entitled "Employee Retirement Income Security Act
of l974, Rules and Regulations for Administration and Enforcement; Claims Procedure; Final
Rule" (29 CFR 2560).
· Establishes that the regulations adopted under §
15-1010(b)(1)(i) of the Insurance Article governing individual disability benefit policies
may not take effect until July 1, 2004.
Effective date: October 1, 2003
· Amends § 15-1502 of the Insurance Article to require the Maryland Health Care Commission to conduct an evaluation of existing mandated health insurance services and make recommendations to the General Assembly regarding decision-making criteria for reducing the number of mandates or the extent of coverage.
· Requires the Maryland Health Care Commission to consider
certain factors when evaluating existing mandated health insurance services.
· Requires the Maryland Health Care Commission, beginning on
January 1, 2004, and every four years after, to submit a report of its findings to the
General Assembly.
Effective date: July 1, 2003
· Alters the definition of "covered service" to mean a
health care service included in the benefit package of the health maintenance organization
and rendered to a member or subscriber of the health maintenance organization by:
(1)
A provider under contract with the health maintenance
organization, when the service is obtained in accordance with the terms of the benefit
contract of the member or subscriber; or
(2)
A noncontracting provider under § 19-710.1 of the
Insurance Article when the service is:
(I)
Obtained in accordance with the terms of
the benefit contract of the
(II)
Obtained pursuant to a verbal or written
referral by:
1. The health maintenance organization of the member or
2. A provider under written contract with the
health maintenance organization of the member or
subscriber; or
(III)
Preauthorized or otherwise approved either verbally
or in writing by:
1. The health maintenance organization of the
member or subscriber; or
2. A provider under written contract with the
health maintenance organization of the member or subscriber.
· Under § 19-710(p)(3)(ii) of the Insurance Article, clarifies
that a health care provider or a representative of a health care provider may collect or
attempt to collect from a subscriber or enrollee "any payment or charges for services
that are not covered services."
Effective
date: October 1, 2003
· Allows the Insurance Commissioner to consider an applicant for
certification as a private review agent to have met certain certification requirements
under § 15-10B of the Insurance Article if:
(1) The applicant has
obtained utilization management accreditation from an approved accrediting organization as
determined by the Insurance Commissioner;
(2) The approved
accrediting organization has requirements that meet or exceed the particular requirement
in § 15-10B of the Insurance Article; and
(3) The applicant
demonstrates that the applicant meets or exceeds the particular requirement under §
15-10B of the Insurance Article.
· Prohibits the Insurance Commissioner from issuing a certificate
to an applicant with utilization management accreditation by an approved accrediting
organization unless the applicant meets all the requirements of
· Establishes that a report of an approved accrediting
organization used by the Insurance Commissioner as evidence that the applicant has met a
particular requirement for a private review agent certificate shall be made available by
the Insurance Commissioner to the public on request.
Effective
date: October 1, 2003
· Among other things, requires the Insurance Commissioner to
develop a form to implement the requirements of § 15-127(D) of the Insurance Article.
· Amends § 15-127 of the Insurance Article to define certain
terms.
· Establishes that the provisions of § 15-127 of the Insurance
Article do not apply to a person that, for an administrative fee only, solely arranges a
provider panel for a carrier for the provision of behavioral health care services on a
discounted fee-for-service basis.
· Requires a carrier that owns or contracts with a managed
behavioral health care organization to:
(1)
Include information on behavioral health care providers in
the list of providers on the carrier's
provider panel required under § 15-112(j) of the Insurance Article.
(2) Provide the same information on behavioral health
care providers that is
· Amends § 15-127(c) to require a carrier that contracts with a
managed behavioral health care organization to require the managed behavioral health care
organization to provide to the carrier on an annual basis a report on the direct
behavioral health care expenses of the managed behavioral health care organization.
· The report required to be provided under § 15-127(c)(4) of the
Insurance Article shall be made publicly available by the carrier.
· Under § 15-127(e)(2) of the Insurance Article, a carrier
required to make a form publicly available under § 15-127(c)(4) of the Insurance Article
may charge a fee.
Effective date: October 1, 2003
· Among other things, amends § 14-504 of the Insurance Article
to require the Plan administrator to deposit all premiums for plan enrollees in a separate
account, titled in the name of the State of Maryland, for the Maryland Health Insurance
Plan.
· Establishes that the Plan administrator may use the money in
the account only to pay claims for plan enrollees.
· Requires the Plan administrator to keep complete and accurate
records of all transactions for the separate account.
· Allows the Maryland Health Insurance Plan Board to adjust the
premium rate based on member age under certain circumstances.
· Amends § 14-513 of the Insurance Article to allow the Board to
determine whether premiums collected for the Program shall be deposited:
(1)
To a segregated account in the Fund established under §
14-504 of the Insurance Article; or
(2)
To a separate account for the Program established by the
carrier that administers the Program.
· For the final quarter of fiscal year 2003, establishes that the
Health Services Cost Review Commission shall determine the amount equal to the value of
the SAAC purchaser differential for each hospital for which rates have been approved by
the Commission.
Effective date: April 8, 2003
· Applies to each individual, group, or blanket health insurance
policy, contract, or certificate of an insurer or nonprofit health service plan that :
(1) (I) Is
delivered or issued for delivery in the State;
(II)
Is issued to a group that is incorporated or has a main
office in
(III)
Covers individuals who reside or work in the State; and
(2) Is
issued, renewed, amended, or reissued on or after October 1,
· Establishes that if a policy, contract, or certificate subject
to this law provides for reimbursement for a service that is within the lawful scope of
practice of a licensed clinical professional counselor, a licensed clinical marriage and
family therapist, or a licensed clinical alcohol and drug counselor, the insured or any
other person covered by the policy or certificate is entitled to reimbursement for the
service.
Effective date: October 1, 2003
· Amends § 19-705.1(b) of the Health-General Article to require
the Secretary of the Department of Health and Mental Hygiene to include in the standards
of quality of care a requirement that each member of a health maintenance organization
shall have an opportunity to select a primary physician or a certified nurse practitioner
from among those available to the health maintenance organization.
· Under § 19-705.1(c), provides that a member of a health
maintenance organization may select a certified nurse practitioner as the member's primary
care provider if:
(1) The certified nurse practitioner provides
services at the same location as
(2) The collaborating physician provides the
continuing medical
· Under § 19-705.1(c) of the Health-General Article, a member
who selects a certified nurse practitioner as a primary care provider must be provided the
name and contact information of the certified nurse practitioner's collaborating
physician.
· In accordance with § 19-705.1(c)(3) of the Health-General
Article, a health maintenance organization is not required to include certified nurse
practitioners on the health maintenance organization's provider panel as primary care
providers.
Effective date: October 1, 2003
· Amends § 14-501 of the Insurance Article by expanding the
definition of ”medically uninsurable
individual" to include individuals "eligible for the tax credit for health
insurance costs under § 35 of the Internal Revenue Code."
· Amends § 14-503 of the Insurance Article to add two members to
the Maryland Health Insurance Plan Board of Directors, appointed by the Insurance
Commissioner, of which one member shall be a representative of carriers operating in the
State and one member shall be a representative of insurance producers selling insurance in
the State.
· Under §14-503(L) of the Insurance Article, the bill requires
that for members enrolled in the Plan based on eligibility for the federal tax credit for
health insurance costs under § 35 of the Internal Revenue Code, the Board shall report to
the Governor and General Assembly by December 1 of each year the number of members
enrolled and the cost to the Plan associated with providing coverage to these members.
· The bill also requires that a carrier that issues Medigap shall
issue any Medigap policy the carrier sells in the State to an individual eligible for
Medicare if:
(1) The individual is enrolled under an employee welfare
benefit plan that provides health benefits;
(2)
The employee welfare benefit plan in which the individual
is enrolled terminates;
(3)
Solely because of eligibility for Medicare, the individual
is not eligible for credit for health insurance costs under § 35 of the Internal Revenue
Code and enrollment in the Maryland Health Insurance Plan under § 14-501(f) of the
Insurance Article, as enacted by Section 1 of this Act; and
(4)
The individual applies for the Medigap policy no later
than 63 days after the employee welfare benefit plan terminates.
· Requires the Maryland Insurance Administration to issue notice
of the requirements regarding Medigap to each affected carrier in the State.
· Requires the Maryland Insurance Administration, on or before
October 1, 2003, to notify the Centers for Medicare and Medicaid Services that the State
has established the Plan and requests that the Plan be approved as an acceptable
"alternative mechanism" under the Federal Health Insurance Portability and
Accountability Act - 45 CFR 148.128(e).
Effective date: April 8, 2003
· Establishes that the purpose of § 14-102 of the Insurance
Article is to:
(1)
Regulate the formation and operation of nonprofit
health service plans in the State; and
(2)
To promote the formation and existence of nonprofit
health service plans in the State that:
(I)
Are committed to a nonprofit corporate
structure;
(II)
Seek to provide individuals, businesses, and
other groups with
(III)
Recognize a responsibility to contribute to the
improvement of the overall health status of Maryland
residents.
· Establishes that a nonprofit health service plan that complies
with the
provisions of § 14-102 of
the Insurance Article is declared to be a public
benefit corporation that is
exempt from taxation as provided by law.
· Under § 14-102(c) of the Insurance Article, establishes the
mission of the nonprofit health service plan.
· Under § 14-102(d) of the Insurance Article, requires a nonprofit health service plan to:
(1)
Develop goals, objectives, and strategies for carrying out
its statutory mission;
(2)
For a certain period of time, report quarterly, for the
preceding quarter, to the Joint Nonprofit Health Service Plan Oversight Committee on the
nonprofit health service plan's compliance with the provisions of Title 14 of the
Insurance Article; and
(3)
Provide to the Joint Nonprofit Health Service Plan
Oversight Committee any other information necessary for the Committee to meet the goals
outlined under § 2-10A-08 of the State Government Article.
· Applies to:
(1)
A nonprofit health service plan that is issued a
certificate of authority in the State, whether or not organized under the laws of the
State; and
(2)
An insurer or health maintenance organization, whether or
not organized as a nonprofit corporation, that is wholly owned or controlled by a
nonprofit health service plan that is issued a certificate of authority in the State.
· Under § 14-102(h) of the Insurance Article, exempts certain
nonprofit health service plans from the provisions of the law.
· Under § 14-106(c) of the Insurance Article, amends the manner
in which a nonprofit health service plan may satisfy the public service requirement.
· Under § 14-106(d) of the Insurance Article, requires a
nonprofit health service plan that is subject to this law and issues comprehensive health
care benefits in the State to:
(1)
Offer health care products in the individual market;
(2)
Offer health care products in the small employer group
market in accordance with Title 15, Subtitle 12 of the Insurance Article; and
(3)
Administer and subsidize the Senior Prescription Drug
Program established under Title 14, Subtitle 5, Part II of the Insurance Article.
Effective
date: May 22, 2003
· Extends the sunset provision in § 15-832 of the Insurance
Article.
· Provides for § 15-832 of the Insurance Article to sunset on
September 30, 2006.
Effective date: October 1, 2003
· Repeals uncodified language from Chapter 119 of the Acts of
1998 that required each insurer, nonprofit health service plan, and health maintenance
organization subject to the Act to submit to the Insurance Commissioner a report that
describes the clinical trials covered during the previous year.
· Repeals uncodified language from Chapter 119 of the Acts of
1998 that required the Insurance Commissioner to compile an annual summary report based on
certain information provided to the Insurance Commissioner on clinical trials.
Effective date:
June 1, 2003
· Establishes a task force to study and make recommendations
regarding:
(1)
Whether any changes should be made to the mental
health parity requirements under § 15-802 of the Insurance Article and § 19-703.1 of the
Health-General Article;
(2)
The systematic barriers experienced by commercially
insured individuals when attempting to access community treatment;
(3)
How to ensure that commercially-insured individuals have
access to medically necessary mental health treatment;
(4)
The difference in mental health services coverage provided
by the public mental health system, commercial health insurers, and commercial health
maintenance organizations;
(5)
The structure and effectiveness of the public and private
mental health care delivery systems in the State; and
(6)
The impact on the cost of health care coverage in the
State of any recommended changes to the coverage or delivery of mental health care
services.
· Requires the Task Force to issue a preliminary report of its
findings on or before December 31, 2003 and a final report of its findings on or before
December 31, 2004.
· Requires the Maryland Insurance Administration and the
Department of Health and Mental Hygiene to jointly staff the Task Force.
· Establishes the membership of the Task Force, including the
Insurance Commissioner or his designee.
· Requires the Insurance Commissioner to appoint two members of
the Task Force:
(i) One
representative of the commercial health insurance industry; and
(ii) One
representative of a commercial health maintenance organization.
Effective date: July 1, 2003
· Amends § 16-504 of the Insurance Article so that the minimum
nonforfeiture amount, under certain circumstances, is at an interest rate of 1.5% per
year.
· Imposes a two-year sunset provision so that the law expires May
31, 2005.
Effective date: June 1, 2003
· Amends § 15-1204 of the Insurance Article to permit a carrier
to offer benefits in addition to those in the Standard Plan if, among other things, the
carrier:
(1)
Clearly
distinguishes the Standard Plan from other offerings of the carrier;
(2)
Indicates the Standard Plan is the only plan required by
State law; and
(3)
Specifies that all enhancements to the Standard Plan are
not required by
· Amends § 15-1207 of the Insurance Article to lower the rate
cap for the Standard Plan from 12% to 10%.
· Requires the Maryland Health Care Commission, in consultation
with the Maryland Insurance Administration, to conduct an analysis of and make
recommendations on the administrative cost of health plans in the small group market,
including:
(1)
The total amount and distribution of administrative costs;
(2)
The strategies of lowering administrative costs; and
(3)
The appropriateness of the medical loss ratios specified
in § 15-605(c)(1) of the Insurance Article.
Effective date: July 1, 2003
· Amends § 16-215 of the Insurance Article to clarify that a
policy of individual life insurance may not be delivered or issued for delivery in the
State if the policy excludes or restricts liability for death that is the result of an act
of terrorism that the covered person did not commit and in which the covered person did
not participate.
· Amends § 17-101 of the Insurance Article to prohibit the
delivery or issuance for delivery in the State of a policy of group life insurance if the
policy excludes or restricts liability for death that is the result of an act of terrorism
that the covered person did not commit and in which the covered person did not
participate.
Effective date: July 1, 2003
· Amends § 15-112(j) of the Insurance Article to:
(1)
Require a carrier to make
available to prospective enrollees on the Internet and, on request of a prospective
enrollee, in printed form:
(I) A list
of providers on the carrier's provider panel; and
(II) Information on
providers that are no longer accepting new patients.
(2)
Require a carrier to notify each enrollee at the
time of initial enrollment
and renewal how to obtain the following information on the
Internet and in printed form:
(I)
A list of providers on the carrier's provider panel; and
(II)
Information on providers that are no longer accepting new
patients.
Effective
date: October 1, 2003
· Under § 27-304.1 of the Insurance Article, requires the
Insurance Commissioner to adopt regulations that establish standards and procedures for:
(1)
The settlement of claims involving the total loss of a private
passenger
(2)
The determination of the
private passenger motor vehicle's total loss value.
Effective date: October 1, 2003
· Amends § 27-501(I)(1)(vi) of the Insurance Article to clarify
that a violation of § 21-902(a), (c), or (d) of the Transportation Article does not
require statistical validation for an insurer to cancel or refuse to underwrite or renew
an insurance risk pursuant to § 27-501 of the Insurance Article.
Effective date:
June 1, 2003
· Amends § 25-405(f)(1) of the Insurance Article to increase the
maximum limit of liability from $500,000 to $1,500,000 on real or personal property
comprised of or contained in a single building.
· Repeals § 25-405(f)(1)(ii), which subjects contiguous parcels
of land to the maximum limit of liability.
Effective date: October 1, 2003
· Under § 23-301.1 of the Insurance Article, authorizes a
premium finance agreement to include any:
(1)
Premium receipts tax that a surplus lines broker is
required to charge under § 3-324 of the Insurance Article and pay to the Insurance
Commissioner under § 3-325 of the Insurance Article;
(2)
Policy fee that a surplus lines broker is allowed to
charge under
(3)
Inspection fee
that a surplus lines broker is allowed to charge under
· Amends § 23-304 of the Insurance Article to require the
finance charge to be computed on the amount of the entire premium loan advanced, including
any taxes or fees that are financed under § 23-301.1 of the Insurance Article.
Effective date: October
1, 2003
· Establishes under § 5-904 of the Insurance Article that credit
may not be allowed, as an asset or deduction from liability, to a ceding insurer for
reinsurance, unless:
(I)
The reinsurer is authorized to transact insurance
business in the State
(II) The
reinsurance contract provides, in substance, that in the event of the
· Section 5-904(a)(2) requires that payments made by a reinsurer
in accordance with § 5-904(a)(1)(II) to be made directly to the ceding insurer or its
domiciliary receiver unless:
(I) The reinsurance contract or other
written agreement specifically provides
(II) Subject
to any contractual or statutory requirement of consent by the
· Under § 5-904(a)(3), establishes the rights and obligations of
a reinsurer in the event that a life and health guaranty association has elected to
succeed the rights and obligations of an insolvent insurer.
· Under § 5-904(B) of the Insurance Article, provides a
reinsurer with certain rights, including the right to investigate a claim and interpose,
in the liquidation proceeding, any defense that it determines is available to the
insolvent ceding insurer or its receiver.
Effective
date: October 1, 2003
· Amends § 2-112 of the Insurance Article to repeal the current
fee for approval by the Insurance Commissioner of continuing education courses.
· Amends § 10-110 of the Insurance Article to allow the
Insurance Commissioner to appoint an advisory board for life and health insurance and an
advisory board for property and casualty insurance.
· Amends § 10-116 of the Insurance Article to allow the
Insurance Commissioner to review continuing education courses and approve or disapprove
continuing education courses.
· Amends § 10-118 of the Insurance Article to require insurers
to maintain a producer register in lieu of filing a notice of every producer appointment
or termination with the Insurance
Commissioner.
Effective
date: July 1, 2003*
(*The
provisions in § 10-118 of the Insurance Article take effect on January 1, 2004.)
· Amends § 27-209(4) of the Insurance Article to prohibit a
person from knowingly offering, promising or giving any valuable consideration not
specified in the contract, except for educational materials, promotional
· Amends § 27-212 of the Insurance Article to prohibit a person
from knowingly offering, promising, or giving any valuable consideration not specified in
the contract, except for educational materials, promotional materials, or articles of
merchandise that cost less than $10, regardless of whether a policy is purchased.
Effective date: October 1, 2003
· Amends § 5-505 of the Insurance Article to require certain
insurers and their boards to behave in a certain manner when making investments or loans.
· Amends § 5-511 of the Insurance Article to allow insurers to
invest in certain classes of investments.
· Amends § 5-511 to define limits on an insurer's ability to
invest in medium-
Effective date: October 1, 2003
· Amends § 10-125(f) of the Labor and Employment Article so that
the Fund is not subject to the excessive premium growth charge or any other penalty
associated with premium growth in any risk based capital calculation.
· Section 10-125(f) of the Labor and Employment Article is
effective until January 1, 2005.
Effective
date: October 1, 2003
· Amends § 5-512(k)(2) of the Insurance Article so that if a
separate investment account provides a fixed guaranteed return that is not subject to
market value adjustment, a life insurer is required to hold assets that equal or exceed
the reserve amount that would be required if the separate investment account was an
obligation of the life insurer's general account.
· Requires an asset held under § 5-512(k)(2)((I) to be valued in
accordance with §§ 5-401 and 5-402 of the Insurance Article.
Effective date: October 1, 2003
· Exempts a domestic insurer from keeping certain assets in the
State.
· Under § 4-115(c)(1)(ii)(4) of the Insurance Article, exempts
securities held
· Under § 4-115(c)(1)(ii)(5) of the Insurance Article, exempts
transactions or securities involved in transactions authorized by § 5-111(n) and (o) of
the Insurance Article or any other transactions exempted by the Insurance Commissioner
from this paragraph.
· Repeals § 4-115(d) of the Insurance Article, which prohibits a
domestic
· Amends § 5-511(o)(2)(ii)(1.) of the Insurance Article to
require the board of directors to approve a derivative use plan that, among other things:
"Describes investment objectives and risk constraints,
such as counterparty exposure amounts and collateral arrangements supporting derivative
transactions".
Effective date:
October 1, 2003