(a) (1) This section applies only to individual plans and small group plans.
(2) The requirements in this section are in addition to and not in substitution of any other requirements of law related to prescription drug benefits.
(b) (1) Except as provided in paragraph (2) of this subsection, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with 45 C.F.R. § 156.122.
(2) If the Commissioner adopts regulations as described in subsection (c) of this section, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with the regulations adopted by the Commissioner.
(c) To the extent necessary, the Commissioner shall adopt regulations that:
(1) establish criteria to determine whether an individual plan or a small group plan provides prescription drug essential health benefit coverage; and
(2) are consistent with 45 C.F.R. § 156.122 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
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