Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations

SB 474 requires Maryland health insurance carriers to submit quarterly reports to the Insurance Commissioner detailing denied coverage requests (e.g., for hospital stays, procedures). If a carrier’s denials for a specific service type rise by over 10% in one year or 25% over three years, they must explain the reasons for the increase. The Commissioner can use this data to trigger examinations of carriers and must publish an annual summary report for the Governor and legislature. The bill directly affects health insurers operating in Maryland, with compliance required starting October 1, 2025. It focuses on transparency around coverage denials without specifying outcomes for patients or insurers.