Sec. 10.25.08.01. Scope

This chapter applies to each carrier that participates in the health benefit plan quality and performance evaluation system.

This chapter requires participation in the health benefit plan quality and performance evaluation system by each carrier that:

(1) Holds a certificate of authority in the State;

(2) Has a premium volume in Maryland for each category of health benefit plan that exceeds $1,000,000; and

(3) Has no more than 65 percent of its Maryland enrollees covered through the Medicaid and Medicare Programs (for each category of health benefit plan), as reported in an annual statement submitted by a carrier to the Commission that includes premium volume and enrollment percentages for the calendar year preceding the reporting period.

The evaluation system described in this chapter is designed to address the information needs of consumers and purchasers by providing an assessment of the quality and performance of health benefit plans based on measures endorsed or implemented by nationally recognized organizations involved in quality of care and performance measurement.