Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.32 - Nonprofit Health Service Plans-Material Modification
Section 31.10.32.03 - Material Modification
Universal Citation: MD Code Reg 31.10.32.03
Current through Register Vol. 51, No. 19, September 20, 2024
For purposes of Insurance Article, § 14-115(d)(11)(i), Annotated Code of Maryland, a modification is material if it modifies:
A. The options available in a health benefit plan marketed in the State in a manner that results in a change of 20 percent or more in the actuarial benefit value of the health benefit plan;
B. A provider network in a manner that results in a change of:
(1) 10 percent or more in the number of health care providers in the provider network:
(a) For the entire State: or
(b) In the Baltimore metro region or DC metro region;
(2) 7 percent or more in the number of health care providers in the provider network in the Southern Maryland region;
(3) 5 percent or more in the number of health care providers in the provider network in the Eastern Shore region or Western Maryland region;
(4) 10 percent or more in the number of health care providers in a key specialty in the provider network:
(a) For the entire State; or
(b) In the Baltimore metro region, DC metro region, Eastern Shore region, Southern Maryland region, or Western Maryland region;
(5) 10 percent or more in the amount of reimbursement paid to health care providers in the provider network:
(a) For the entire State; or
(b) In the Baltimore metro region or DC metro region;
(6) 7 percent or more in the amount of reimbursement paid to health care providers in the provider network in the Southern Maryland region; or
(7) 5 percent or more in the amount of reimbursement paid to health care providers in the provider network in the Eastern Shore region or the Western Maryland region;
C. Underwriting guidelines for a product of a nonprofit health insurance plan in a manner that results in:
(1) A refusal to provide the least expensive rate for the product of a nonprofit health service plan to 20 percent or more of applicants for the product; or
(2) A relative increase of 50 percent or more in the current level of refusals to provide the least expensive rate for the product of a nonprofit health service plan to applicants; or
D. Rates or rating plans that are required to be approved by the Commissioner in a manner that results in:
(1) A rate increase of 15 percent or more in 1 year for any product sold by a nonprofit health service plan in a particular market; or
(2) A rate increase of 25 percent or more in 1 year for coverage variations within a product sold by a nonprofit health service plan in a particular market.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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