Health Insurance - Primary Care Investment Targets - Reimbursement and Reporting

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0494*

HOUSE BILL 494
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By: Delegate Bagnall
Introduced and read first time: January 27, 2026
Assigned to: Health
Committee Report: Favorable
House action: Adopted
Read second time: February 18, 2026

CHAPTER ______

AN ACT concerning 1

Health Insurance – Primary Care Investment Targets – Reimbursement and 2
Reporting 3

FOR the purpose of requiring certain entities to provide reimbursement to health care 4
providers in a manner that meets the annual primary care investment targets 5
established by the State on or after a certain date; requiring certain entities to 6
provide a description of the entity’s progress in meeting the annual primary care 7
investment targets to the Maryland Insurance Commissioner when filing a premium 8
rate or premium rate change with the Commissioner; and generally relating to 9
health insurance and primary care investment targets. 10

BY repealing and reenacting, with amendments, 11
Article – Insurance 12
Section 11–603(c) 13
Annotated Code of Maryland 14
(2017 Replacement Volume and 2025 Supplement) 15

BY adding to 16
Article – Insurance 17
Section 15–717 18
Annotated Code of Maryland 19
(2017 Replacement Volume and 2025 Supplement) 20

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
That the Laws of Maryland read as follows: 22
2 HOUSE BILL 494

Article – Insurance 1

11–603. 2

(c) (1) Any applicable premium rate or premium rate change of a carrier 3
subject to this subtitle shall be filed with the Commissioner: 4

(i) for insurers, in accordance with § 12 –203 of this article and 5
regulations adopted under Title 31, Subtitle 10 of the Code of Maryland Regulations; 6

(ii) for nonprofit health service plans, in accordance with § 14–126 of 7
this article; and 8

(iii) for health maintenance organizations, in accordance with § 9
19–713 of the Health – General Article and regulations adopted under Title 31, Subtitle 12 10
of the Code of Maryland Regulations. 11

(2) (i) The Commissioner shall d isapprove or modify a proposed 12
premium rate filing if the proposed premium rates appear, based on statistical analysis and 13
reasonable assumptions, to be inadequate, unfairly discriminatory, or excessive in relation 14
to benefits. 15

(ii) In determining whether to disapprove or modify a premium rate 16
filing of a carrier, the Commissioner shall consider, to the extent appropriate: 17

1. past and prospective loss experience in and outside the 18
State; 19

2. underwriting practice and judgment; 20

3. a reasonable margin for reserve needs; 21

4. past and prospective expenses, both countrywide and 22
those specifically applicable to the State; and 23

5. any other relevant factors in and outside the State. 24

(3) WHEN FILING A PREMIUM RATE OR PREMIUM RATE CHANGE WITH 25
THE COMMISSIONER UNDER THIS SUBSECTION , A CARRIER SHALL SUBMIT A 26
DESCRIPTION OF THE CARRIER ’S PROGRESS IN ME ETING THE ANNUAL PRIMARY 27
CARE INVESTMENT TARG ETS ESTABLISHED BY THE STATE AS REQUIRED UND ER § 28
15–717 OF THIS ARTICLE. 29

[(3)] (4) (i) Each premium rate filing and any supporting information 30
filed under this subtitle shall be open to public inspection as soon as filed. 31
HOUSE BILL 494 3

(ii) A carrier may request a finding by the Commissioner that certain 1
information filed with the Commi ssioner be considered confidential commercial 2
information under § 4 –335 of the General Provisions Article and not subject to public 3
inspection. 4

(iii) On request and payment of a reasonable fee, a person may obtain 5
copies of a premium rate filing and any supporting information. 6

15–717. 7

(A) THIS SECTION APPLIES TO INDIVIDUAL, GROUP, OR BLANKET HEALTH 8
INSURANCE POLICIES A ND CONTRACTS DELIVER ED OR ISSUED FOR DEL IVERY IN 9
THE STATE BY INSURERS , NONPROFIT HEALTH SER VICE PLANS , AND HEALTH 10
MAINTENANCE ORGANIZATIONS. 11

(B) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE 12
REIMBURSEMENT TO HEALTH CARE PROVI DERS IN A MANNER THAT MEETS THE 13
ANNUAL PRIMARY CARE INVESTMENT TARGETS ESTABLISHED BY THE STATE ON OR 14
AFTER FEBRUARY 1, 2026. 15

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 16
October 1, 2026. 17

Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.