§ 15-1A-18

Maryland § 15-1A-18

• Jurisdiction: Maryland
• Article gin: Insurance
• Title: 15

Text

(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 31, 2024.

(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.