(a)    This section applies to a carrier with respect to any health benefit plan that:

(1)    is not a grandfathered health plan, as defined in § 1251 of the Affordable Care Act; and

(2)    is issued, delivered, or renewed in the State on or after January 1, 2014.

(b)    (1)    Except as provided in this subsection and § 31–110(f) of this article, a carrier may not offer health benefit plans to small employers in the State unless the carrier also offers qualified health plans, as defined in § 31–101 of this article, in the Small Business Health Options Program of the Maryland Health Benefit Exchange in compliance with the requirements of Title 31 of this article.

(2)    A carrier is exempt from the requirement in paragraph (1) of this subsection if:

(i)    the reported total aggregate annual earned premium from all health benefit plans offered to small employers in the State for the carrier and any other carriers in the same insurance holding company system, as defined in § 7–101 of this article, is less than $20,000,000;

(ii)    the Commissioner determines that the carrier complies with the procedures established under paragraph (3) of this subsection; and

(iii)    when the carrier ceases to meet the requirements for the exemption, the carrier provides to the Commissioner immediate notice and its plan for complying with the requirement in paragraph (1) of this subsection.

(3)    The Commissioner shall establish procedures for a carrier to submit evidence each year that the carrier meets the requirements necessary to qualify for an exemption under paragraph (2) of this subsection.

(4)    Notwithstanding the exemption provided in paragraph (2) of this subsection, the Commissioner, in consultation with the Maryland Health Benefit Exchange:

(i)    may assess the impact of the exemption provided in paragraph (2) of this subsection and, based on that assessment, alter the limit on the amount of annual premiums that may not be exceeded to qualify for the exemption; and

(ii)    shall make any change in the exemption requirement by regulation.