Sec. 31.11.11.03. Required Notice — Initial Purchase of Coverage

A. At the time of the initial purchase of coverage, a carrier who offers benefits additional to the benefits offered in the Comprehensive Standard Health Benefit Plan shall obtain a signed disclosure statement certifying that:

(1) The small employer was offered the Standard Comprehensive Health Benefit Plan; and

(2) Additional benefits were offered and priced separately.

B. The disclosure statement required in §A of this regulation shall be in at least 12-point type and shall read as follows:

"MARYLAND HEALTH INSURANCE REFORM ACT COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN DISCLOSURE STATEMENT

Under Maryland law, small employers, including self-employed individuals and certain government and nonprofit organizations, as defined by Insurance Article, §15-1203, Annotated Code of Maryland, must be offered the Comprehensive Standard Health Benefit Plan ("Standard Plan") by each carrier when health coverage is elected or renewed.

A carrier may not offer small employers a health benefit plan having fewer benefits than the Standard Plan. A carrier may offer benefits in addition to those in the Standard Plan provided the optional, additional benefits are offered and priced separately from the Standard Plan. A small employer who is subject to the federal Mental Health Parity and Addiction Equity Act of 2008 shall be offered, at a minimum, the Standard Plan plus an additional benefit rider to make the mental health and substance abuse benefits comply with the federal Mental Health Parity and Addiction Equity Act of 2008.

I HAVE READ AND UNDERSTAND THIS DISCLOSURE STATEMENT. I ACKNOWLEDGE THAT I HAVE RECEIVED A DESCRIPTION OF THE STANDARD PLAN AND RATES AND ANY ADDITIONAL BENEFITS AND RATES HAVE BEEN SHOWN AND PRICED SEPARATELY.

Name of Carrier:

Name of Producer:

Employer Name:

Employer Signature: Date: ".

C. The disclosure statement required by §A of this regulation may be included on the carrier's sales proposal sheet.

D. The carrier or insurance producer shall maintain the signed disclosure statement for not less than 5 years.