all of the Mandatory Benefits that insurance companies are required to provide. Your
contract may also include exclusions that are not described here or may include benefits
that are not required by law. If a health carrier fails to provide Mandatory Benefits, or does
not offer benefits which it is required by law to offer, the carrier may be subject to fines or
sanctions, including the payment of restitution, if appropriate. If you believe a carrier has
violated the insurance law, you may file a complaint with the Maryland Insurance
Administration (MIA).
Below, please find a list of benefits that must be offered by certain carriers under certain
circumstances (“Mandatory Offerings”), followed by a discussion regarding Mandatory
Benefits. Attached is a chart containing a list of Mandated Benefits and the types of plans
that must provide coverage for these Mandated Benefits along with a description of when
a carrier may impose a deductible or copayment.
Mandatory Offerings
The following coverages must be offered by certain carriers in certain situations:
Alzheimer’s Disease Treatment – This optional benefit covers expenses arising from the
care of individuals with Alzheimer’s Disease and includes nursing home care and
intermediate or custodial nursing care. Only group insurers and nonprofit health service
group plans must offer this coverage. (Insurance Article §15-801)
Disability Benefits for Disabilities Caused by Pregnancy or Childbirth – Insurers offering
group policies that provide benefits for temporary disability must offer the policyholder the
option to purchase coverage for temporary disability caused or contributed by pregnancy
or childbirth. (Insurance Article §15-813)
Hospice Services – Inpatient and Outpatient – This optional benefit covers the services
of hospice, a coordinated care program for people who are dying and their family
members. By law, all health carriers are required to offer this benefit. (Health General
Article § 19-703(c) for HMOs; Insurance Article § 15-809 for all other carriers)
Are All Health Benefit Plans Required By Law To Include Mandatory Benefits?
The law exempts certain carriers and health benefit plans from the requirement to provide
Mandatory Benefits and the requirement to make Mandatory Offerings. These include:
Group policies issued to the group’s home office which is not located in Maryland.
If you work for an employer whose home office is located in another state, your
health insurance policy may have been issued in that other state. The MIA
regulates only those policies issued or delivered in Maryland. This also applies
if you are an individual insured under a group policy issued to an association that
is not located in Maryland.
The federal government’s health benefit plans. States do not regulate federal
government health benefit plans.