(a) A carrier may offer a catastrophic plan in the individual market in accordance with the requirements of this section.
(b) A catastrophic plan may be offered only to individuals who:
(1) are under the age of 30 years before the beginning of the plan year; or
(2) hold certification for a hardship exemption or an affordability exemption as required in subsection (c) of this section.
(c) (1) Except as provided in paragraph (2) of this subsection, to be offered a catastrophic plan, an individual shall hold certification for a hardship exemption or an affordability exemption under 42 U.S.C. § 5000A.
(2) If the Maryland Health Benefit Exchange adopts regulations as described under subsection (d) of this section, an individual shall hold certification for a hardship exemption or an affordability exemption under the regulations adopted by the Exchange.
(d) To the extent necessary, the Maryland Health Benefit Exchange shall adopt regulations that:
(1) establish a process for issuing hardship exemptions and affordability exemptions; and
(2) are consistent with 42 U.S.C. § 5000A and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
(e) (1) Subject to paragraph (2) of this subsection, a catastrophic plan shall provide coverage for essential health benefits.
(2) A catastrophic plan shall require a deductible that:
(i) is equal to the annual limit on cost–sharing described in § 15–1A–19 of this subtitle;
(ii) applies to essential health benefits;
(iii) does not apply to at least three primary care visits each plan year; and
(iv) does not apply to any covered benefits for which a deductible is prohibited under this title.
Structure Maryland Statutes
Subtitle 1A - Consumer Protections
Section 15-1A-01 - Definitions
Section 15-1A-02 - Enforcement of Provisions by Commissioner
Section 15-1A-04 - Criteria for Health Benefit Plans -- Consistent With Federal Law
Section 15-1A-06 - Certain Factors Prohibited in Consideration -- Extra Premiums Prohibited
Section 15-1A-07 - Premium Rates Review -- Basis -- Ratio of Premium Rate Variation
Section 15-1A-09 - Acceptance of All Employers and Individuals -- Exceptions
Section 15-1A-11 - Lifetime or Annual Limits on Benefits
Section 15-1A-12 - Limit on Waiting Period for Otherwise Eligible Individual
Section 15-1A-14 - Emergency Services -- Coverages
Section 15-1A-16 - Acceptable Medical Loss Ratio -- Calculation
Section 15-1A-18 - Catastrophic Plans -- Regulations Governing
Section 15-1A-20 - Prescription Drug Essential Health Benefits for Individual and Small Group Plans
Section 15-1A-21 - Rescission of Coverage Under Health Benefit Plans -- Exceptions