On May 3, 2023, Gov. Moore signed HB 1217/SB 805 into law. The law requires health insurers in Maryland to cover biomarker testing when supported by medical and scientific evidence. Cost-sharing for biomarker testing may not be greater than cost-sharing for similar covered services. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information.

HB 1217 »

On May 3, 2023, Gov. Moore signed HB 785/SB 515 into law, addressing protocols imposed by health insurers that require an insured to use a certain prescription drug or sequence of prescription drugs before covering a prescription drug ordered by a provider (known as “step therapy” or “fail-first” protocols).

Specifically, the law requires health insurers in Maryland to establish a process for insureds to request an exception to a step therapy or fail-first protocol, with deference to the prescriber. The law also prohibits requiring more than a certain number of prior authorizations for a prescription for different dosages of the same prescription drug. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information.

HB 785 »

On May 3, 2023, Gov. Moore signed HB 376/SB 184 into law. The law prohibits health insurers in Maryland from imposing cost-sharing on coverage for diagnostic breast examinations and supplemental breast examinations, with the exception of required cost-sharing under a qualified HDHP prior to meeting the deductible. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information.

HB 376 »

On May 3, 2023, Gov. Moore signed HB 815/SB 965 into law. The law requires health insurers in Maryland to cover follow-up diagnostic lung cancer screenings without cost-sharing, with the exception of required cost-sharing under a qualified HDHP prior to meeting the deductible. As of January 1, 2024, the law applies to policies issued or delivered in the state. Employers sponsoring health plans in Maryland should be aware of this development and contact their carriers for further information.

HB 815 »

On May 3, 2023, Gov. Moore approved SB0828/HB0988, which delays the implementation Maryland’s paid family and medical leave program, known as the Time to Care Act of 2022. The Time to Care Act applies to employers with at least one employee in Maryland, though employers with fewer than fifteen employees are not required to make employer contributions. More information on the Time to Care Act can be found in the April 26, 2022, edition of Compliance Corner.

Most notably, contributions have been delayed until October 1, 2024 (previously, October 1, 2023). Benefits will now be available to eligible employees beginning January 1, 2026 (previously, January 1, 2025). Other notable modifications include:

• The definition of family member is expanded to include domestic partners;
• The requirement for employees to exhaust paid vacation, sick leave or other paid time off provided under their employers’ policies before or while receiving benefits is eliminated;
• The premium contribution allocation between an employer and employees will be a 50-50 split;
• Total contributions may not exceed 1.2% of an employee’s wages (applied to all wages up to and including the Social Security wage base);
• Contribution rates will be set by October 1, 2023; and
• Regulations must be issued by January 1, 2024.

This delay allows additional time to prepare for meeting the Time to Care Act’s requirements. Employers with at least one employee in Maryland should monitor the state’s Department of Labor website for updates.

SB0828/HB0988 »

On March 31, 2023, the Maryland Insurance Administration issued a bulletin in response to Braidwood Management Inc. v. Becerra, a judgment that invalidates and prohibits enforcement of certain ACA preventive care requirements on a nationwide basis. More information concerning this case can be found in an April 11, 2023, article in Compliance Corner. The bulletin confirms to carriers that the Braidwood decision does not impact health benefit plans issued in Maryland.

Bulletin 23-6 »

On March 17, 2023, the Maryland Insurance Administration (MIA) announced revisions to certain essential health benefits (EHBs) included in Maryland’s benchmark plan. The benchmark plan sets minimum standards of coverage under fully insured small group plans (and individual plans) issued in the state. MIA determined certain benefits and exclusions in the Maryland benchmark plan are discriminatory and must be revised. In particular, regarding small group plans, visit limits for habilitative services for adults must be removed.

Bulletin 23-5 »

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 »

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 »

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 »