MD| Bulletin 25-12, from the Maryland Insurance Administration, provides guidance for insurers, nonprofit health service plans, and HMOs in Maryland on how to request exemption from participation in the Maryland Health Benefit Exchange for 2026, outlining eligibility based on specific premium thresholds and procedural requirements.
Key Points
- Carriers may be exempt from offering qualified health plans in the SHOP or Individual Exchange if their aggregate annual earned premiums fall below $20,000,000 for small employer plans or $10,000,000 for individual plans, or if they offer only student health plans.
- Exemption eligibility is determined using premium data from two years prior to the requested exemption year (2024 data for 2026 exemptions), and the exemption request must be in writing, signed by an authorized carrier representative, and submitted to the Maryland Insurance Administration.
- Requests based on premium thresholds are due by December 15, 2025, and requests based solely on student health plan offerings are due by February 2, 2026, with detailed instructions on submission included in the bulletin.