July 01, 2025
In May 2025, Gov. Moore signed the following health insurance bills into law:
- HB 1315 requires health insurance carriers to cover child wellness vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention as of December 31, 2024.
- HB 11/SB 902 requires health insurance carriers to establish procedures allowing members to request referrals to specialists outside the carrier’s network under specific circumstances, such as when the carrier lacks an in-network specialist with the appropriate expertise or cannot provide timely access to in-network care. When a member is approved for a referral to an out-of-network specialist, the carrier cannot impose additional utilization review requirements beyond what would be required for an in-network provider. For mental health and substance use disorder services, carriers must provide additional assistance to members in identifying and arranging out-of-network care. The law also ensures that members will not face higher out-of-pocket costs for these out-of-network specialist services, effectively treating them as in-network.
- HB 869/SB372 requires health insurance carriers to reimburse telehealth services (including audio-only) at the same rate as if the visit were in person. The law takes effect immediately.
- HB 936 requires health insurance carriers to send electronic notice of cancellation of coverage of a small employer health benefit plan to each enrolled employee. A small employer is defined as one that employed 50 or fewer employees during the preceding calendar year. This requirement is in addition to the written notice requirements under current law. The notice must include information on additional health coverage options under COBRA or the Maryland Health Benefit Exchange.
- HB 970/SB 646 prohibits health insurance carriers from imposing a step therapy or fail-first protocol for FDA-approved insulin or insulin analogs used to treat Type 1, Type 2, or gestational diabetes.
- HB 666/SB 60 requires health insurance carriers to provide coverage for calcium score testing in accordance with the most recent guidelines issued by the American College of Cardiology.
- HB 1086 requires health insurance carriers, when covering anesthesia for a procedure, to provide coverage for medical care related to the delivery of anesthesia provided immediately before and after the procedure, without any time limitations on the delivery of anesthesia.
- HB 1087/SB 921 prohibits health insurance carriers from imposing a step therapy or fail-first protocol for an FDA-approved covered prescription drug prescribed by a treating physician and supported by peer-reviewed medical literature to treat stage four advanced metastatic cancer or a side effect from treatment.
- HB 1243/SB 975 prohibits health insurance carriers from excluding coverage for certain specialty drugs that are administered by an in-network oncology services provider if the specialty drugs meet certain qualifications and medical necessity criteria.
- HB 1301 prohibits health insurance carriers from requiring prior authorization for transfer to a special pediatric hospital.
- HB 1355/SB 641 requires health insurance carriers to cover medically necessary hearing aids ordered, fitted, and dispensed by a licensed hearing aid dispenser. Coverage is already required for medically necessary hearing aids that are prescribed, fitted, and dispensed by a licensed audiologist.
- SB 773 requires health insurance carriers to include certain discounts, financial assistance payments, product vouchers, or other out-of-pocket expenses made by or on behalf of the enrollee when calculating certain cost-sharing contributions for certain prescription drugs. These requirements do not apply when calculating a deductible under an HDHP. Further, health insurers may not condition coverage on the availability of financial assistance for a prescription drug.
Unless otherwise noted above, these laws apply to policies issued, delivered, or renewed in Maryland on or after January 1, 2026.
Employers sponsoring health plans issued, delivered, or renewed in Maryland should be aware of these developments and contact their carriers for further information. These state insurance laws do not apply to self-insured group plans.