Plan Certification Standards Released
The Maryland Health Benefit Exchange Board of Trustees has approved the Plan Certification Standards for 2019. We thank all who provided feedback and responses to the Draft.
The Maryland Health Benefit Exchange (MHBE), Maryland’s state-based marketplace, partners with insurance carriers to offer a variety of affordable and high quality insurance plans. Maryland Health Connection (MHC), a service of the Maryland Health Benefit Exchange, is the marketplace for insurance carriers to “connect” with Marylanders who need coverage. Through our comprehensive online marketplace, authorized carriers will be able to present a variety of qualified health plans (QHPs) for Marylanders, and their families, to enroll in. MHC is the only place where individuals and small businesses can:
- Determine eligibility for Medicaid or Qualified Health Plans
- Learn about the tax subsidies for which they qualify
- Do a side-by-side comparison of health plans to determine the plan that best fits their needs
- Select and enroll into the health insurance plan of their choice
At the end of the 2018 Open Enrollment period 153,571 Marylanders enrolled in private health coverage through MHC. A total of 39,334 Marylanders enrolled in dental coverage. Daily enrollment in
QHPs for 2018, was up 69% compared to the prior open enrollment. There was an average of 2,953 enrollments each day during the 52 day period, compared to 1,752 average daily enrollments during a 90 day enrollment period a year ago.
MHBE is accepting applications from health insurance carriers to sell QHPs and SADPs through MHC. Applications must be received by July 2, 2018, in order to participate during the 2019 Open Enrollment period.
The Maryland Health Benefit Exchange, in collaboration with the Maryland Insurance Administration and the Maryland Health Care Commission, has designed a multi-step process to authorize carriers and certify benefit designs for Maryland Health Connection. By completing all steps, carriers can offer qualified plans to individuals and/or small businesses that purchase through Maryland Health Connection.
How Does My Carrier Participate?
Step 1: Complete Carrier Application Package.
Step 2: Submit Benefit Designs, Forms and Rates to the Maryland Insurance Administration for Review/Approval.
Step 3: Submit Plan Certification Information to MHBE via SERFF.
Step 4: Complete a Carrier Business Agreement and Non-Exchange Entity Agreement (biennial).
Carrier Application Materials
(Please note that this form is a fillable PDF document. Save to your computer and open using Adobe Reader in order to complete the application.)
Maryland Health Connection Plan Management Program
MHBE will authorize any licensed insurance carrier (including insurers, non-profit health service plans, health maintenance organizations (HMOs), dental plan organizations, and consumer operated and oriented plans (CO-OPs)) to offer qualified plans on Maryland Health Connection as long as the carrier meets federal requirements and market participation rules established under federal and Maryland’s state law.
The Small Business Health Options Program (SHOP)
MHBE provides Maryland’s small businesses access to quality health plans that suit their employees through the SHOP. Maryland’s SHOP administrator, BenefitMall, provides small business marketplace services including administrative, technical and operational services.
The program uses the SHOP administrator and authorized brokers to connect small businesses with the tax credit-eligible qualified health plans offered by participating insurance carriers. Small businesses also may purchase SHOP-certified stand-alone dental plans through the Maryland SHOP.
Carrier Reference Manual
The Maryland Health Benefit Exchange has developed a Carrier Reference Manual to provide insurance carriers with details on the process for authorization and plan certification. This manual will be updated annually to include the most current policy, operational and IT developments so that carriers can keep abreast of key requirements for offering plans on Maryland Health Connection. The manual is issued in January each year, and Plan Certification standards are finalized by February of each year.
For all other Carrier documents and reports, please visit the Carriers & Shop Administrators Toolbox page.
Your Feedback Matters!
The Maryland Health Benefit Exchange values feedback from carriers. If you have a question or a suggestion for how we can partner with insurance carriers, please contact us at firstname.lastname@example.org.
For more helpful information for carriers, visit the Plan Management Stakeholder Committee page.
Supplemental Maryland Reinsurance Program
Plan Certification Materials