(a) Except as provided in subsections (b) through (d) of this section, a carrier shall accept every employer and individual in the State that applies for a health benefit plan, subject to the following provisions of this article: (1) Subtitle 4 of this title; (2) §§ 15-1206(c), 15-1208.1, 15-1208.2, 15-1209, and 15-1210 of this title; (3) §§ 15-1316 and 15-1318 of this title; and (4) §§ 15-1406 and 15-1406.1 of this title. (b) (1) Except as provided in paragraph (2) of this subsection, a carrier may restrict enrollment to open or special enrollment periods. (2) A carrier that offers a large group plan shall allow an employer eligible to purchase a large group plan to purchase a large group plan at any time during the year. (c) If a carrier uses a network for a health benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier, the carrier: (1) (i) may limit the employers that may apply for coverage to employers of eligible individuals who live, work, or reside in the service area for the network; and (ii) if the carrier is a health maintenance organization, may limit the individuals who may apply for coverage in the individual market to those who live or reside in the service area for the network; or (2) may deny coverage within a service area if the carrier: (i) demonstrates to the Commissioner that: 1. the carrier does not have the capacity to deliver adequate services to additional enrollees of groups or additional individuals because of its obligations to existing group contract holders and enrollees; and 2. the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status-related factor; and (ii) does not offer coverage within the service area for at least 180 days after the date the carrier denied coverage in the service area. (d) A carrier may deny coverage if the carrier: (1) demonstrates to the Commissioner that: (i) the carrier does not have the financial reserves necessary to underwrite additional coverage; and (ii) the carrier applies the denial of coverage uniformly to all employers and individuals without regard to the claims experience or any health status-related factor; and (2) unless a later date is otherwise authorized by the Commissioner, does not offer the denied coverage for at least 180 days after the date the carrier denied the coverage.
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