Health Insurance in Maryland is regulated by the Maryland Insurance Administration. General provisions regarding health insurance benefits in Maryland are found in the Insurance Article of the Maryland Annotated Code in Title 15 (“Insurance Article”), Subtitle 1 including but not limited to coverage, reimbursement and compensation issues. Read the Law: Md. Code Ann., Ins. §§ 15-101 - 15-143.
Regulations relating to for health insurance are found in Code of Maryland Regulations (“COMAR”) Title 31, Subtitle 10.
The Insurance Article in Subtitle 8 lists a number of required health insurance benefits including but not limited to benefits for the elderly, those individuals diagnosed with Alzheimer’s disease, treatment for mental illnesses, prescription medications, in vitro fertilization procedures, disabilities caused by pregnancy or childbirth, breast cancer screenings and hospice care. Consumers can appeal a denial of coverage for medical treatment online, or by filing a complaint with the Maryland Insurance Administration. When an HMO or health insurer denies coverage for treatment, it must do so in writing. After an adverse decision or denial, your health plan must give you the details of its internal grievance process so that you can file an appeal with your health plan if you choose.
If you decide to file an appeal, the Maryland Attorney General's Health Care Education and Advocacy Unit will assist you, free-of-charge, in filing your appeal. The Health Education and Advocacy Unit may be reached toll-free at 1-877-261-8807.
Health Benefit Exchange
The Health Benefit Exchange Article, Title 31 of the Annotated Code, addresses the law in Maryland to reduce the number of uninsured citizens in the State. To buy health insurance through the Health Benefit Exchange, visit their Connector Entities page. Read the law: Md. Code Ann., Md. Health Exchange §§ 31-102 et. seq.
Affordable Care Act
The 2010 Patient Protection and Affordable Care Act (ACA) created a new way to get health insurance. The ACA require states to establish and operate a health insurance exchange or participate in a federal exchange. Maryland set up the Maryland Health Connection as a marketplace to enroll in health plans.