State and Territory Updates

Maryland

November 08, 2022

MarylandSaves Program Effective September 1, 2022

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The MarylandSaves Program was created in 2016 with HB 1378 and went into effect on September 1, 2022. The program is a state-run retirement savings program for employers who do not otherwise offer employees a savings arrangement. Such arrangements include an IRA, defined benefit plan, 401(k), Simplified Employee Pension (SEP) plan, a Savings Incentive Match Plan for Employees (SIMPLE) plan or another arrangement, if in compliance with federal law, that the state board specifies by regulation. Employers who do not sponsor such an arrangement for employees must now meet certain requirements.

Those employers must register with the MarylandSaves Program, automatically enroll employees in the program and withhold and forward five percent of each employee’s compensation each pay period. Each employee’s contribution will automatically increase by one on January 1 of each year up to the maximum 10%. Employees may opt out or change their contribution percentage at any time. All contributions will be placed in a Roth IRA. Lastly, covered employers must distribute the program description to employees, which details the program and opt-out instructions.

Importantly, employers who already sponsor a qualified savings arrangement for employees must file an exemption. Employers qualify if they have sponsored an arrangement in the current or preceding calendar year. Governmental employers are also exempt.

HB 1378, 2016 »
Program Description, Employer Notice »
Employer Registration »
Employer Exemption »


August 30, 2022

Coverage for Rituximab

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On May 12, 2022, Gov. Hogan signed HB 820 into law. The new law requires health insurance policies issued or renewed on or after January 1, 2023, to provide coverage for rituximab for the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute onset neuropsychiatric syndrome (PANS).

Employer plan sponsors of fully insured policies issued in Maryland should be aware of the coverage change and work with the insurer to update plan documents as necessary.

HB 820 »


June 22, 2022

Coverage for HIV Prevention Prescription Drugs

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On May 29, 2022, HB 970 was enacted. Effective January 1, 2023, the new statute prohibits health insurers from imposing a prior authorization requirement for prescription drugs used as post-exposure prophylaxis for the prevention of HIV, if the drug is prescribed in accordance with CDC guidelines. This prohibition will apply to group health insurance policies issued in the state and which provide coverage for prescription drugs. Employer plan sponsors should verify with their insurer that the appropriate changes are made to the policy and documents.

HB 970 »


June 22, 2022

Coverage for Prescription Drugs to Treat Diabetes, HIV and AIDS

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On May 16, 2022, Gov. Hogan signed HB 1397 into law. Effective for policies issued on or after January 1, 2023, the new law prohibits insurers from imposing a copayment or coinsurance greater than $30 for a 30-day supply of insulin drugs or $150 for a 30-day supply of a prescription drug to treat diabetes, HIV or AIDS. The requirements apply to group health insurance policies issued in the state and which provide coverage for prescription drugs. Employer plan sponsors should verify with their insurer that the appropriate changes are made to the policy and documents.

HB 1397 »


April 26, 2022

Maryland Enacted Mandatory Paid Family and Medical Leave Program

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On April 9, 2022, Maryland enacted its statutory Family and Medical Leave Insurance (FAMLI) program by the state legislature overriding Gov. Hogan’s veto. The FAMLI program is also known as the “Time to Care Act of 2022” (Senate Bill 275) and applies to employers who have at least one employee working in Maryland. The payroll withholding of the employees’ contributions is scheduled to begin on October 1, 2023, and the benefits will be available to eligible employees starting January 1, 2025.

Below are the key highlights of FAMLI:

Timeline

  • June 1, 2023: Maryland Secretary of Labor will set the contribution rates
  • October 1, 2023: Contributions to the FAMLI program begin
  • January 1, 2025: Benefits will be available to employees

Covered Employers

An employer who employs at least one employee working in Maryland.

Funding of the Program

Beginning October 1, 2023, employees and employers with 15 or more EEs are required to contribute to the state’s Family Medical Leave Insurance (FAMLI) fund. (The Maryland Secretary of Labor will determine the rates by June 1, 2023.)

Eligibility to Take Leave

Employees who have worked at least 680 hours over the 12-month period in Maryland immediately preceding the date on which leave is to begin.

Qualified Reasons for Leave

 Employees’ own serious health condition and for an eligible employee to:

  • Care for a family member with a serious health condition
  • Bond with a new child (by birth, adoption or fostering) during the first 12 months after the child’s birth or placement
  • Care for a next-of-kin service member
  • Attend to a qualifying exigency arising out of a family member’s military deployment.

Maximum Benefits Duration

  • 12 weeks within the 12-month period following the employee applying for benefits.
  • An additional 12 weeks (i.e., total 24 weeks) is provided if the employee received benefits for childcare during the first year of a new child’s birth or adoption and then becomes eligible for benefits due to the employee’s serious health condition (or vice versa).
  • Leave can be taken continuously or intermittently (a minimum increment of 4 hours).

Maximum Benefits Amount

Based on each employee’s average weekly wage ranges from $50 to $1,000 cap per week, then indexed to inflation from the subsequent years.

Notice to Employees

Employers must provide written notice to each covered employee to inform them of the employee’s rights and duties under the FAMLI program when an employee is hired and annually thereafter. Additionally, employers must provide the notice when an employee requests FAMLI leave. The Maryland Department of Labor will develop standard notices for employers to use in the future.

Employers who have at least one employee in Maryland should be aware of this new update.

Senate Bill 275 »


April 27, 2021

Mandated Coverage for Certain COVID-19 Antibody Therapies

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On March 22, 2021, Commissioner Birrane invoked her emergency powers to require health insurance carriers to provide coverage for monoclonal antibody therapies. This includes Bamlanivimab and the combination of Casirivimab and Imdevimab. Any cost sharing, including copayments, coinsurance and deductibles must be waived.

Although this mandated coverage applies to health insurance carriers, employer plan sponsors should be aware of this change.

Bulletin 21-09 »


December 08, 2020

Infertility Coverage Changes for 2021

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The Maryland Legislature enacted SB988 on May 8, 2020. Effective for policies issued or renewed on or after January 1, 2021, SB 988 requires the following changes to infertility coverage:

  • Infertility coverage is available to all subscribers, not just those that are married. Thus, unmarried subscribers will be eligible for infertility coverage where they could have previously been excluded from such.
  • An insured that is married to the opposite sex must have a demonstrated one-year history of intercourse failing to result in pregnancy (previously two years).
  • If the insured and the spouse are of the same sex, they must demonstrate three attempts of artificial insemination over a one-year period that failed to result in pregnancy; OR the insured or spouse has one of four medical conditions (endometriosis, exposure in utero to diethylstilbestrol, blockage of surgical removal of at least one fallopian tube, or abnormal male factors). The requirement was previously six attempts in two years. This same requirement applies to unmarried subscribers.

Employers should work with carriers to revise plan documents and communicate changes to participants.

SB988 »


August 18, 2020

Paid Sick Leave Revised

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Effective October 1, 2020, HB 880 revises the definition of a family member for Maryland paid sick leave (under the Maryland Healthy Working Families Act) to include the legal guardian or ward of the employee or the employee’s spouse. As a reminder, employees (of employers with 15 or more employees) earn one hour of paid sick leave for every 30 hours worked up to an annual maximum of 40 hours. Smaller employers must provide unpaid leave.

This leave may be taken so that an employee can care for an ill family member, among other reasons. For this purpose, the term family member already included a biological/adopted/step/foster child, a child under the employee’s legal guardianship, a child for whom the employee has physical or legal custody, a child for whom the employee stands in loco parentis, the employee’s or spouse’s biological/adoptive/step/foster parent, the employee’s spouse, an individual who stood in loco parentis of the employee or spouse, biological/adoptive/step/foster grandparent of the employee, biological/adopted/step/foster grandchild of the employee, and a biological/adopted/step/foster sibling of the employee.

Employers should revise their paid sick leave policy appropriately.

HB 880 »


May 27, 2020

Coverage for Pediatric Autoimmune Neuropsychiatric Disorders

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Effective for health insurance policies issued on or after January 1, 2021, SB 475 requires coverage for medically necessary diagnosis, evaluation and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Coverage must be provided for intravenous immunoglobulin therapy. Coverage is not required for Rituximab unless the US FDA approves the use of Rituximab for this purpose.

SB 475 »


March 31, 2020

Accommodations for Nonpayment of Premiums During COVID-19 State of Emergency

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On March 20, 2020, the Insurance Administration published Bulletin No. 20-10. The bulletin relates to the difficulties individuals and businesses may be facing as a result of the State of Emergency declared by the governor on March 5, 2020, in connection with COVID-19. The bulletin encourages carriers to make reasonable accommodations so that individuals and businesses don’t lose coverage due to nonpayment of premium during the emergency. Reasonable accommodations may include suspension of premiums due, extension of billing due dates and premium grace periods, and waiver of installment and late payment fees. Carriers should also use electronic payment technology on websites, apps and electronic bank transfers whenever possible.

The bulletin contains no new employer compliance obligations. Maryland employers that may be in a difficult spot with cash flow or other business issues, though, may want to reach out to their carrier with respect to some of the accommodations above that may be available.

Bulletin No. 20-10 »


March 31, 2020

Maryland Health Connection Announces Special Enrollment Window for all Marylanders

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On March 20, 2020, the Maryland Health Connection – Maryland’s state health insurance exchange – announced that any uninsured Marylander can enroll in Maryland Health Connection health coverage beginning March 16, 2020, through April 15, 2020. Marylanders do not need a special enrollment event to enroll; the window is open for anyone who is otherwise eligible. The announcement also confirms that all medically necessary screening and testing for COVID-19 are free of charge, and that all health plans available through the Maryland Health Connection.

For employers, the announcement does not bring new compliance obligations. However, employers should be aware of the opportunity for furloughed employees to enroll on the exchange should they be terminated from their group health plan coverage.

Announcement »


March 17, 2020

Health Insurance Coverage for Coronavirus

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The Maryland Insurance Administration (MIA) recently published several bulletins relating to health insurance coverage of the coronavirus (COVID-19), and other measures relating to public emergencies. These include Bulletin No. 20-05 (published on March 6, 2020), Bulletin No. 20-06 (published on March 10, 2020), and Bulletin No. 20-06 (published on March 13, 2020), as described below.

Bulletin No. 20-05 requires carriers to waive any time restrictions on prescription medication refills and authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the medication had most recently been filled by a pharmacist (thus allowing individuals to obtain medications in advance of any quarantine). Importantly, copayments and deductibles may apply to the prescription medication refills (in accordance with the terms of the carrier’s contract/policy). The bulletin also states that emergency regulations would soon be published relating to coverage requirements of COVID-19, which were finalized in Bulletin 20-06.

Bulletin No. 20-06 outlines specific requirements enacted as part of emergency regulations published. According to those emergency regulations, carriers must waive any cost-sharing (including co-payments, coinsurance and deductibles) for:

  • Any visit to diagnose or test for COVID-19, regardless of the setting of the testing
  • Laboratory fees to diagnose or test for COVID-19
  • Vaccination for COVID-19, when a vaccine becomes available

In addition, carriers must evaluate a request to use an out-of-network provider to perform diagnostic testing of COVID-19 solely on the basis of whether the use of the out-of-network provider is medically necessary or appropriate. Also, carriers must consider an adverse decision on a request for coverage of diagnostic services for COVID-19 an emergency case for which an expedited grievance procedure is required. The only prior authorization requirements that a carrier may utilize relating to COVID-19 test is one relating to the medical necessity of the testing. The cost-sharing waivers do not apply to Medicare supplement policies.

Bulletins No. 20-05 and 20-06 apply directly to carriers, but are important reminders on coverage of COVID-19-related services and items.

Lastly, according to Bulletin No. 20-07, the MIA reminds carriers that CMS has developed a HCPCS code that will be used by laboratories to bill for certain COVID-19 tests (and it includes a link to the CMS website for more information). This bulletin relates more to carriers and administrators, but may be helpful for employers should questions arise on proper billing of laboratory tests relating to COVID-19.

Bulletin No. 20-05 »
Bulletin No. 20-06 »
Bulletin No. 20-07 »


December 11, 2018

Mandated Coverage for Lymphedema

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Effective for group health insurance policies issued or renewed on or after Jan. 1, 2019, HB 847 requires coverage for the medically necessary diagnosis, evaluation and treatment of lymphedema. Coverage must include equipment, supplies, complex decongestive therapy, gradient compression garments and self-management training and education. Gradient compression garments refers to custom-fit garments prescribed by a health care provider and does not refer to disposable over-the-counter supplies. The plan’s normal annual deductibles, copayments and coinsurance requirements may apply to the coverage.

HB847 »


December 11, 2018

Mandated Coverage for 12-Month Contraceptive Supply

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Effective for group health insurance policies issued or renewed on or after Jan. 1, 2020, HB 1283 requires coverage for a single dispensing of prescription contraceptives up to a 12-month supply, which are prescribed by a health care provider. The previous limitation was a 6-month supply.

HB 1283 »


October 16, 2018

Male Sterilization Coverage Under HDHPs

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On April 10, 2018, Gov. Hogan signed SB 137 into law and it became effective upon signing. The new bill permits high deductible health plans (HDHPs) issued in Maryland to apply male sterilization expenses to the deductible. As background, effective Jan. 1, 2018, all policies issued in MD had to provide coverage for male sterilization without applying the cost to the deductible. However, this caused a problem for the HDHPs as the IRS clarified in March, 2018, through IRS Notice 2018-12: male sterilization didn’t fall under the preventative care category and such coverage would have to be subject to a deductible or the HDHP would fail to be HSA qualified.

There is transition relief in place until Dec. 31, 2019 that permits HSA eligible individuals to have coverage under an HDHP that applies no cost sharing to male sterilization. The relief simply stated it applied to periods prior to 2020. This seems to indicate that the relief applies on a tax year basis and not on a plan year basis. Thus, some carriers are starting to apply male sterilization to the deductible for policy years beginning on or after Jan. 1, 2019. This is so that the HDHP may maintain its qualified status for the months of the policy year that run into 2020 (for example, a policy year that begins Feb. 1, 2019 and ends Jan. 31, 2020).

Importantly, SB 137 includes a provision that if the IRS includes male sterilization as a preventive care expense in the future, then the SB 137 amendment permitting HDHPs to apply male sterilization to the deductible would automatically be void.

SB 137 »


May 15, 2018

Mandated Coverage for Fertility Instruction

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On May 8, 2018, Gov. Hogan signed HB 249 into law. The new law requires group health insurance plans to provide coverage for certain instruction related to fertility awareness-based methods. “Fertility awareness-based methods” include cervical mucus method, symptom-thermal or symptom-hormonal method, the standard days method and the lactational amenorrhea method. The coverage must not be subject to participant cost sharing. It’s effective for policies issued or renewed on or after Jan. 1, 2019.

HB 249 »


March 20, 2018

Healthy Working Families Act - Sample Policies Now Available

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On March 9, 2018, the Maryland Department of Labor, Licensing and Regulation (DLLR) released a revised series of frequently asked questions (FAQs). The FAQ document identifies which responses have been revised and added with the notations "REVISED" and "NEW," respectively.

Included in the new guidance is a clarification of the construction exemption. Employees in the construction industry are exempt from the earned safe and sick leave law if they're covered by a collective bargaining agreement (CBA) that was entered into before June 1, 2017. The exemption will remain in place for the duration of the contract, excluding any extensions. If the CBA was entered into on or after June 1, 2017, the employees may be subject to the earned safe and sick leave law, depending on the specific terms of the CBA.

The DLLR also clarifies that an employer may use different accrual methods for different types of employees. For example, an employer could front-load leave time for full-time employees while requiring part-time employees to earn leave time on an accrued basis.

Paid safe and sick leave may be credited toward the fringe benefit requirement on a Maryland Prevailing Wage project. However, the DLLR doesn't address whether the paid leave could be credited toward the fringe benefit requirement under the Davis Bacon Act, deferring to the DOL who administers the federal law.

Finally, the DLLR also provides a revised poster and sample model policies for an employer to adopt and communicate to employees. There are three different samples: one for employers that front-load the leave time at the beginning of the year, one for those that award leave time on an accrued basis throughout the year and a third policy specifically for restaurant employees with tipped employees. The policies require some customization regarding whether the leave is paid or unpaid, and employee notice procedures.

Healthy Working Families Act, Revised FAQs »
Healthy Working Families Act, Revised Poster »
Healthy Working Families Act, Sample Policies »


March 06, 2018

Healthy Working Families Act Update

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As discussed in the Jan. 23, 2018 edition of Compliance Corner, Maryland's Healthy Working Families Act went into effect Feb. 11, 2018. SB 304 would have delayed the effective date to July 1, 2018. The bill passed the Senate but did not pass the House.

The new law requires employers with 15 or more employees to provide paid leave to eligible employees working in Maryland. Employees accrue one hour for every 30 hours worked. Accrual begins Feb. 11, 2018. Employers with fewer than 15 employees must provide unpaid leave to employees working in Maryland.

Eligible employees are defined as those working more than 12 hours per week. There are exemptions for independent contractors, employees under the age of 18, agricultural employees, certain employees of a staffing agency, certain on-call workers in the health or human services industry, and certain workers in the construction industry.

On Feb. 5, 2018, the Maryland Department of Labor, Licensing and Regulation (DLLR) released a memo providing additional guidance on the new law. When determining the employer's size, only those employees performing work in Maryland should be counted. All employees are included in the calculation (part-time, full-time, temporary and seasonal).

In regards to hours worked:

  • If an employee works primarily in another state but performs work in Maryland that is incidental to their work performed elsewhere, the employee wouldn’t be entitled to accrue sick and safe leave for those incidental hours or work performed in Maryland.
  • If an employee performs the majority of their work in Maryland, the employee is entitled to accrue sick and safe leave for all time worked, including any incidental work that’s performed in another state.

On Feb. 16, the Maryland DLLR also released a draft sample poster and a series of frequently asked questions (FAQs). The FAQs provide important clarification on many issues, including:

  • The law applies to all employers who have one or more employees whose primary work location is in Maryland, regardless of where the employer is located.
  • The act preempts any local paid sick and safe leave laws enacted on or after Jan. 1, 2017. The act does not preempt Montgomery County’s sick and safe leave act as it was enacted prior to Jan. 1, 2017.
  • If an employer has an existing leave policy that provides leave benefits that are equivalent to or greater than those provided under the act, the employer doesn’t need to provide additional leave. It’s advised that such employers advise employees that they won’t be providing additional leave above and beyond what’s already provided.
  • An employer may prohibit the use of accrued leave during the employee’s first 15 weeks of employment.
  • If an employee is rehired within 37 weeks, the employee is entitled to have any earned but unused sick leave reinstated.

NFP's Benefits Compliance team will keep you updated on any developments, including the release of the final poster and forthcoming sample policies from the DLLR, in future editions of Compliance Corner.

Maryland DLLR FAQs »
Healthy Working Families Act, Sample Draft Poster »
Maryland DLLR Memo »
H.B. 1, Maryland Healthy Working Families Act »


January 23, 2018

Healthy Working Families Act

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On Jan. 12, 2018, the Maryland Legislature overrode Gov. Hogan’s May 2017 veto of HB 1, the Healthy Working Families Act. The new law is effective Feb. 11, 2018, and requires employers with 15 or more employees to provide paid sick and safe leave to eligible employees. Employers with 14 or fewer employees are required to provide unpaid leave. To calculate size, the employer must determine the average monthly number of employees in the preceding calendar year. All employees are included in the calculation (part-time, full-time, temporary and seasonal).

Eligible employees accrue one hour of leave for every 30 hours worked up to a maximum annual accrual of 40 hours. Salaried employees accrue based on a 40-hour workweek or their normal workweek. Employees may use up to 64 hours of leave per year. Employees may roll over a maximum of 40 hours to a subsequent year or the employee must frontload the employee’s full amount that would be earned in the year at the beginning of the year. Employees begin to accrue at the start of employment or Feb. 11, 2018, whichever is later. An employer may deny leave during the employee’s first 106 calendar days of employment. Accrued but unused hours are not required to be paid at employee termination.

Employees are eligible if they work 12 hours or more per week. The following workers are not covered by the new law:

  • Independent contractors
  • Employees who are under the age of 18 at the beginning of the year
  • Agricultural employees
  • Workers employed by a temporary staffing agency that does not control the day-to-day work assignments and supervision of the employee
  • Workers employed by an employment staffing agency to provide temporary or part-time services to another employer
  • On-call workers in the health or human services industry who can reject or accept the shift offered and who are not employed by a temporary staffing agency
  • Workers employed in the construction industry and covered by a bona fide collective bargaining agreement in which the safe and sick leave requirement is clearly and specifically waived; janitors, building cleaners, building security officers, concierges, doorpersons, handypersons and building superintendents working in the construction industry are covered by the law

An employer may deny leave if the employee provides services to developmentally disabled or mentally ill individuals, if the leave is foreseeable, if the employer cannot locate a suitable replacement after reasonable efforts and if the absence will cause a disruption of service to at least one client.

Eligible employees may take leave for any of the following reasons:

  • The employee’s or family member’s mental or physical illness, injury or condition
  • The employee’s or family member’s preventive medical care
  • The employee or family member is a victim of domestic violence, sexual assault or stalking
  • Maternity or paternity leave

For this purpose, “family member” is defined as spouses, children, parents, parents-in-law, grandparents and siblings, including all adoptive, biological, foster and step relationships.

Employers can require certification for leaves covering two consecutive scheduled shifts.

The Commissioner of Labor and Industry will make available a poster and notice, which employers will be required to distribute to employees.

Finally, employers with existing leave policies will not be required to provide additional leave if the existing program provides leave equivalent to that required by HB 1.

HB 1 »


September 06, 2017

Preauthorization for Opioid Use Disorder Prescriptions Prohibited

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On May 25, 2017, Gov. Larry Hogan signed H.B. 887 into law. The new law applies to insurers who provide coverage for substance use disorders or prescription drugs. Such insurers are prohibited from applying a preauthorization requirement for a prescription drug used for treatment of an opioid use disorder and that contains methadone, buprenorphine or naltrexone. The law was to be effective for policies issued or renewed on or after Jan. 1, 2018, however, it was enacted as an emergency measure for the immediate preservation of the public health or safety. Therefore, it takes effect for policies issued or renewed on or after the enactment date of May 25, 2017.

H.B. 887 »


September 06, 2017

Coverage for Behavioral Counseling Services

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On May 25, 2017, Gov. Larry Hogan signed H.B. 786 into law. The new law prohibits insurers from denying coverage for a medically necessary covered behavioral health care service provided by a participating provider to a student solely on the basis that the service is provided at a public school or through a school-based health center. The term behavioral health care services means the prevention, intervention and treatment for the social-emotional, psychological, behavioral and physical health of students—including mental health and substance use disorders. The new law was effective for policies issued or renewed on or after July 1, 2017.

H.B. 786 »


September 06, 2017

Coverage for Digital Tomosynthesis

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On May 25, 2017, Gov. Larry Hogan signed S.B. 61 into law. The new law requires certain coverage for digital tomosynthesis, which is a radiological procedure that produces cross-sectional digital three-dimensional images of the breast. Insurers who are required to provide breast cancer screenings must provide coverage for digital tomosynthesis for insureds whose treating physician determines it is medically appropriate and necessary. The insurer may not impose a copayment or coinsurance amount that is greater than for other breast cancer screenings. The law is effective for policies issued or renewed on or after Jan. 1, 2018.

S.B. 61 »


July 11, 2017

Coverage for Partial Supply of Prescription Drugs

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On May 25, 2017, Gov. Hogan signed SB 898 into law. Under the new law, insurers that provide prescription drug coverage must allow insureds to receive a partial supply of a prescription from an in-network pharmacy. The copayment or coinsurance must be prorated accordingly. The prescribing health care provider or pharmacist must determine that dispensing a partial supply is in the best interest of the participant and the purpose is to synchronize the dispensing of the participant’s prescription drugs. The drug must be anticipated to be required for more than three months and is not a Schedule II controlled dangerous substance. The new law is effective for policies issued or renewed on or after Jan. 1, 2019.

SB 898 »


July 11, 2017

Telehealth Services to Include Counseling for Substance Use Disorders

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On May 25, 2017, Gov. Hogan signed HB 983 into law. The new law revises the definition of telehealth services for insurance purposes to include counseling for substance use disorders. Thus, insurers will be required to provide coverage for such counseling through telehealth methods. The law is effective for health insurance policies issued or renewed on or after Oct. 1, 2017.

HB 983 »


July 11, 2017

President Jimmy Carter Cancer Treatment Access Act

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On May 25, 2017, Gov. Hogan signed SB 919 into law. The new law prohibits insurers that provide coverage for prescription drugs from imposing a step therapy or fail-first protocol on a participant when the prescribed drug is approved by the U.S. Food and Drug Administration and the drug is used to treat the participant’s stage four advanced metastatic cancer. Step therapy or fail-first protocol refers to a protocol administered by the insurer that requires a prescription drug or sequence of drugs to be used by the participant before a drug ordered by the participant’s prescribing health care provider can be issued or used. The law is effective for policies issued or renewed on or after Oct. 1, 2017.

SB 919 »


May 31, 2017

Coverage for Art Therapy

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On April 18, 2017, Gov. Hogan signed HB 298 into law. The new law requires insurers to provide benefits for services provided by licensed clinical professional art therapists if the policy otherwise covers services of licensed clinical counselors and therapists. The law is effective Oct. 1, 2017.

HB 298 »


May 31, 2017

Coverage for Diabetes Test Strips

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On April 18, 2017, Gov. Hogan signed HB 730 into law. The new law prohibits group health insurance policies from imposing a deductible, copayment or coinsurance on diabetes test strips. An exception is made for qualified high-deductible health plans, which may subject the strips to the plan’s deductible. The law is effective for policies issued or renewed on or after Jan. 1, 2018.

HB 730 »


November 15, 2016

Montgomery County Amends Paid Sick Leave Law to Include Paid Benefits for Parents

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On Nov. 1, 2016, the Montgomery County Council enacted Bill 32-16, which amends Montgomery County’s recently enacted sick and safe leave law (Bill No. 60-14, covered in the June 1, 2016, edition of Compliance Corner) to include paid benefits for parents. As background, the sick and safe leave law (which took effect Oct. 1, 2016) requires employers to provide most employees in the county with up to 56 hours of paid sick and safe leave. Implementation and actual hours required depend on the size of the employer and type of employee. The new bill amends the law by adding two related purposes for which use of paid leave accrued under the sick and safe leave law will be permitted: Birth of a child or for the placement of a child with the employee for adoption or foster care and to care for a newborn, newly adopted or newly-placed child within one year of birth, adoption or placement. The amendment is effective immediately. Employers in Montgomery County should review the new law and the new amendment and work with their advisor and/or outside counsel in updating their leave policies.

Bill No. 32-16 »
Press Release »


December 15, 2015

MD State Updates - 2015 Jan 15 No.01

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On Nov. 13, 2015, the Maryland Insurance Administration published Bulletin 15-28. The new bulletin notifies insurers that sell medical stop-loss insurance in Maryland about new regulations that have been adopted. The new regulations require insurers to provide a completed medical stop-loss disclosure form to small employers before entering into a policy or contract of medical stop-loss insurance. While neither the regulations nor the bulletin require anything new from employers, small employers that may be contemplating stop-loss insurance should be aware of the new requirement for insurers. The requirement is effective Jan. 1, 2016.

Bulletin 15-28 »


October 20, 2015

MD State Updates - 2015 Jan 20 No.01

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On Oct. 8, 2015, the Maryland Insurance Administration published Bulletin 15-27 regarding the definition of small employer in Maryland law which is “an employer that, during the preceding calendar year, employed an average of not more than 100 employees for plan years that begin on or after Jan. 1, 2016, or another number of employees or date as provided under federal law.” Since Maryland law has been drafted to be consistent with federal law, for plan years that begin on or after Jan. 1, 2016, small employers will be defined as those that employed an average of 50 or less employees during the preceding calendar year. This applies to health benefit plans sold on and off the SHOP Exchange and stand-alone dental contracts sold on the SHOP Exchange.

As background, PPACA included a provision to change the definition of small employer from 1-50 to 1-100 employees effective Jan. 1, 2016. On Oct. 1, 2015, the US Congress passed HR 1624, called the PACE Act. The PACE Act repeals the mandated small-group expansion from groups of up to 50 employees to groups of up to 100 employees. Thus, unless a state has expanded its definition of small employer, PPACA’s insurance mandates would not apply to employers in the 51-100 group in that state.

Bulletin 15-27 »


July 14, 2015

MD State Updates - 2015 Jan 14 No.02

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On May 30, 2015, Gov. Hogan signed HB 838 into law, creating Chapter 483. The new law applies to insurers and relates to coverage for infertility services for same- and opposite-sex couples. For same-sex couples, the law states that for infertility benefits other than in vitro fertilization, insurers may not require that the patient’s spouse’s sperm be used in the covered treatments or procedures or that the patient demonstrate infertility exclusively by means of a history of unsuccessful heterosexual intercourse. Specifically, a same-sex couple may demonstrate infertility by showing six attempts of artificial insemination over the course of two years failing to result in pregnancy. Opposite-sex couples may demonstrate infertility by showing intercourse of at least two years’ duration failing to result in pregnancy.

The new law also prohibits insurers that provide pregnancy-related benefits from excluding benefits for outpatient expenses related to in vitro fertilization for same-sex couples if the patient’s oocytes are fertilized with donor sperm. Lastly, the new law clarifies that insurers are not responsible for any costs incurred in obtaining donor sperm for a same-sex couple.

Although the new law creates no new employer compliance obligations, employers should be aware of the coverage changes, particularly for employees that may be asking questions relating to infertility coverage for both same- and opposite sex couples. Chapter 483 is effective July 1, 2015 (regardless of renewal date).

Chapter 483 »


July 14, 2015

MD State Updates - 2015 Jan 14 No.01

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On July 2, 2015, the Maryland Insurance Administration published Bulletin 15-20, which summarizes 2015 legislation signed into law by Gov. Hogan. Most of the legislation has been covered in previous editions of Compliance Corner; however, three recently-enacted bills have not yet been covered.

The first is SB 450, signed into law April 14, 2015, creating Chapter 35. This law requires insurers to permit an insured, subscriber or member seeking reimbursement for expenses to submit a claim by first-class mail and, at the election of the insurer, by fax or secure website. The law also requires insurers to provide a notice annually describing the methods for reimbursement submissions and instructions on how to submit a claim by fax or website. Insurers must comply with the law by Oct. 1, 2017.

The second is SB 606, signed into law May 12, 2015, creating Chapter 372. This law requires insurers that provide drug coverage to provide coverage for at least two brand-name (and if available, at least two generic) abuse-deterrent opioid analgesic drug products (each containing different analgesic ingredients). The opioid analgesic prescription drugs must be on the lowest cost tier for brand-name or generic prescription drugs on the insurer’s drug formulary, respectively. The new law is effective for plans issued or renewed on or after Jan. 1, 2016.

The third is HB 552, enacted May 30, 2015, creating Chapter 494. This law—relating to medical stop-loss insurance for small employers—increases the minimum specific attachment point for medical stop-loss insurance contracts from $10,000 to $22,500 and the aggregate attachment point from 115 percent to 120 percent of expected claims. There are exceptions for stop-loss policies issued or delivered before June 1, 2015, and for employers that on May 31, 2015, held a stop-loss policy that meets certain conditions. The new law also requires stop-loss insurers to guarantee rates for at least 12 months unless there is a change in benefits, ownership or control of the small employer or a change in the number of covered lives resulting from certain events. Lastly, the law requires employers to provide a notice to small employers describing the total costs, effective/termination dates, renewal provisions, attachment points and limitations on stop-loss coverage. The bill became effective June 1, 2015.

Bulletin 15-20 »
Chapter 35 »
Chapter 372 »
Chapter 494 »


June 02, 2015

MD State Updates - 2015 Jan 02 No.01

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On May 12, 2015, Gov. Hogan signed SB 556 into law. The new law relates to conformity of Maryland law to PPACA. Among other changes, the law requires non-grandfathered insured plans to provide medically necessary treatment for mental illness, emotional disorders and drug and alcohol abuse. Treatment must include inpatient benefits for services provided in licensed or certified facilities (including hospital inpatient services), partial hospitalization benefits and outpatient benefits, including all office visits and psychological and neuropsychological testing for diagnostic purposes. Importantly, ‘partial hospitalization benefits’ means providing medically directed intensive or intermediate short-term treatment to plan participants in licensed or certified facilities or programs for mental illness, emotional disorders or drug and alcohol abuse for a period of more than four but less than 24 hours in a day. In addition, insurers may not charge copayments greater than 50 percent of the daily cost for methadone maintenance treatment.

The new law does not add compliance obligations for employers, but employers that sponsor fully insured plans should be aware of the new coverage requirements. The new law took effect May 12, 2015.

SB 556 »


May 19, 2015

MD State Updates - 2015 Jan 19 No.01

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On May 6, 2015, the Maryland Insurance Administration (MIA) published Bulletin 15-11. The bulletin applies to insurers and relates to Maryland Gov. Hogan’s April 27, 2015, declaration of a state of emergency for the City of Baltimore. On April 30, 2015, as a result of the governor’s declaration, MIA published Bulletin 15-09 (covered in the May 5, 2015, edition of Compliance Corner), which activated an emergency regulation that requires insurers to waive any time restrictions on prescription medication refills and authorize payment to pharmacies in Baltimore for at least a 30-day supply of any prescription medication. According to Bulletin 15-11, on May 6, 2015, the state of emergency for Baltimore was lifted. Therefore the emergency regulation, including the waiver for the time restrictions on prescription medication refill waivers, is no longer in effect. The bulletin does not create any new employer compliance obligations; employers should be aware of the bulletin in case employees have questions relating to prescription coverage during the emergency declaration.

Bulletin 15-11 »


May 19, 2015

MD State Updates - 2015 Jan 19 No.02

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On April 14, 2015, Gov. Hogan signed SB 604 into law, creating Chapter 43. The new law applies to Maryland employers with 15 or more employees and provides certain protections for unpaid interns. According to the law, employers may not fail, refuse or terminate an internship, or otherwise discriminate against an individual with respect to the terms, conditions and privileges of employment (including benefits), based on the individual’s race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity or disability. Employers also must not fail or refuse to make a reasonable accommodation for a known disability of an otherwise qualified intern, and may not discriminate or retaliate against an intern if that intern alleges or otherwise charges the employer of violating their rights under the new law. While the new law does not require benefit coverage for an unpaid intern, it requires employers to review their practices relating to unpaid interns. Since the law also implicates non-benefits laws, such as employment and labor law, employers should work with outside counsel in ensuring compliance. Chapter 43 is effective Oct. 1, 2015.

Chapter 43 »


May 05, 2015

MD State Updates - 2015 Jan 05 No.02

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On April 14, 2015, Gov. Hogan signed SB 241 into law, creating Chapter 23. The new law applies to insurers and relates to coverage for ostomy equipment and supplies. Specifically, the law applies to insurers that provide hospital, medical or surgical benefits to individuals or groups under health insurance policies issued or delivered in Maryland (although there is an exception for policies that provide essential health benefits under PPACA). The law requires coverage of all medically appropriate and necessary equipment and supplies used for the treatment of ostomies including flanges, collection bags, clamps, irrigation devices, sanitizing products, ostomy rings, ostomy belts and catheters used for drainage of urostomies. The coverage must be on the same basis as other similar benefits, meaning cost-sharing (if any) cannot be greater than for ostomy-related equipment and services. The new law is effective for plans and policies issued, delivered or renewed on or after Oct. 1, 2015.

Chapter 23 »


May 05, 2015

MD State Updates - 2015 Jan 05 No.01

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On April 30, 2015, the Maryland Insurance Administration (MIA) published Bulletin 15-09. The bulletin applies to insurers and relates to the Gov. Hogan’s April 27, 2015, declaration of a state of emergency for the City of Baltimore. According to the bulletin, as a result of the governor’s declaration the MIA has activated an emergency regulation for all health insurers in Maryland. The emergency regulation requires such insurers to waive any time restrictions on prescription medication refills and authorize payment to pharmacies in Baltimore for at least a 30-day supply of any prescription medication regardless of the most recently filled date of the prescription. The emergency regulation lasts as long as the state of emergency remains in effect. Although the bulletin applies to insurers, employers will want to be aware of the emergency regulation in case employees have questions regarding coverage of prescription benefits.

Bulletin 15-09 »

Gov. Hogan’s Declaration of Emergency »