reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-104 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-104 - Nonduplication and Coordination Provisions in Policies

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Intensive care policy” means a health insurance policy that provides benefits only for treatment received in the specifically designated facility of a hospital that provides the highest level of care and is restricted to patients who are physically and critically ill or injured.        (3)    “Specified disease policy” has the meaning stated in § 15-109 of this subtitle.    (b)    In accordance with regulations that the Commissioner adopts, the Commissioner shall allow health insurance policies and policies of nonprofit health service plans to contain nonduplication provisions or provisions to coordinate coverage with:        (1)    other health insurance policies, including commercial individual, group, and blanket policies and policies of nonprofit health service plans;        (2)    subscriber contracts that are issued by health maintenance organizations; and        (3)    other established programs under which the insured may make a claim.    (c)    Notwithstanding subsection (b) of this section or any other provision of this article, an individual, group, or blanket health insurance policy, nonprofit health insurance policy, or nonprofit health service plan may not contain a nonduplication provision or provision to coordinate coverage with an individually underwritten and issued, guaranteed renewable, specified disease policy or intensive care policy, that does not provide benefits on an expense-incurred basis.    (d)    Health insurance policies and policies of nonprofit health service plans may not contain a provision that requires personal injury protection benefits under a motor vehicle liability insurance policy to be paid before benefits under the policies.
MD. Insurance Code Ann. §  15-105 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-105 - Coverage Information About Breast Implants

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Breast implant” means a pocket or envelope that is surgically inserted under the skin and contains soft silicone gel, saline solution, or a combination of soft silicone gel and saline solution.        (3)    “Breast implant-related condition” means a condition that the federal Food and Drug Administration recognizes as possibly linked to breast implants.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies that are issued or delivered in the State; and        (2)    health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.    (c)    An entity subject to this section shall provide information to the Commissioner about the entity’s:        (1)    coverage for breast implant removals and breast implant-related conditions; and        (2)    preexisting condition provisions in policies for individuals with breast implants.    (d)    (1)    On request, the Commissioner shall make available to consumers and licensed physicians the information collected under subsection (c) of this section.        (2)    When providing the information, the Commissioner may include a statement that the Commissioner does not guarantee the accuracy of the information.        (3)    The Commissioner may set a fee to cover the cost of providing the information under paragraph (1) of this subsection.    (e)    A licensed physician may make available to a patient the information obtained from the Commissioner under subsection (d) of this section.    (f)    The Commissioner shall adopt regulations to carry out this section, including regulations that determine the extent and format of the information required under subsection (c) of this section.
MD. Insurance Code Ann. §  15-106 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-106 - Home Medical Equipment

    (a)    (1)    An insurer under a contract that provides an individual with home medical equipment pursuant to an individual, group, or blanket health insurance policy or certificate that is delivered or issued for delivery in the State and that provides benefits on an expense-incurred basis:            (i)    shall pay the home medical equipment provider directly if the insured has executed an assignment of benefits; and            (ii)    subject to the copayment and deductible provisions in the insurance contract, may not require the home medical equipment provider to accept less than the agreed monthly rental amount for each month in which benefits are payable under the insurance contract.        (2)    A nonprofit health service plan under a contract that provides a subscriber with home medical equipment pursuant to a health insurance policy or certificate that is delivered or issued for delivery in the State and that provides benefits on an expense-incurred basis:            (i)    shall pay the home medical equipment provider directly if the contract, policy, or certificate of insurance provides for direct payment;            (ii)    may pay the home medical equipment provider or the subscriber receiving the home medical equipment, if the contract, policy, or certificate of insurance does not require direct payment; and            (iii)    may not require the home medical equipment provider to accept less than the agreed monthly rental amount for each month that use of the home medical equipment is authorized by the nonprofit health service plan.    (b)    Authorization may not be terminated until both the provider and beneficiary of the home medical equipment have been notified that authorization is terminated.    (c)    (1)    Rented home medical equipment and services may be purchased with the consent of the provider and insurer if:            (i)    on the insurer’s request either before the initial election to rent the equipment or on the insurer’s receipt of the initial claim from the provider, the purchase price and rental price of the equipment were disclosed to the insurer; and            (ii)    there is no material change in the medical condition of the insured, as certified by the attending physician.        (2)    Rented home medical equipment and services may be purchased with the consent of the provider and nonprofit health service plan in accordance with the benefits available under the applicable health insurance policy or certificate.
MD. Insurance Code Ann. §  15-107 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-107 - Notice to Pharmacies of Change in Pharmaceutical Benefits

    (a)    This section applies to insurers and nonprofit health service plans that issue or deliver individual, group, or blanket health insurance policies in the State.    (b)    At least 30 days before the change is effective, an entity subject to this section that provides pharmaceutical benefits shall notify in writing all pharmacies under contract with the entity of any of the following changes in the pharmaceutical benefit program rules or requirements:        (1)    exclusion of coverage for classes of drugs as specified by the contract;        (2)    changes in prior or preauthorization procedures; or        (3)    selection of new prescription claims processors.    (c)    An entity subject to this section that fails to provide advance notice under subsection (b) of this section shall honor and pay in full any claim under the program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
MD. Insurance Code Ann. §  15-108 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-108 - Record Keeping Procedures

    Each insurer that issues or delivers individual, group, or blanket health insurance policies in the State shall establish record keeping procedures that allow review for overutilization and abuse of the use of hospital, health, and medical services that may result from the actions or activities of the policyholders or certificate holders of the insurer or the providers of hospital, health, and medical services to the insured individuals.
MD. Insurance Code Ann. §  15-109 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-109 - Minimum Loss Ratio for Specified Disease Policies

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Loss ratio” means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State.        (3)    “Specified disease policy” means a health insurance policy that provides:            (i)    benefits only for a disease or diseases specified in the policy or for a treatment unique to a specified disease or diseases; or            (ii)    additional benefits for a disease or diseases specified in the policy or for treatment unique to a specified disease or diseases.    (b)    This section applies to each individual, group, or blanket health insurance policy or nonprofit health service plan that is issued or delivered in the State.    (c)    To administer §§ 12-203, 12-204, and 12-205 of this article, the Commissioner shall establish a minimum loss ratio in accordance with generally accepted actuarial principles with respect to specified disease policies.
MD. Insurance Code Ann. §  15-110 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-110 - Prohibited Referrals

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Health care practitioner” has the meaning stated in § 1–301 of the Health Occupations Article.        (3)    “Health care service” has the meaning stated in § 1–301 of the Health Occupations Article.        (4)    “Prohibited referral” means a referral prohibited by § 1–302 of the Health Occupations Article.    (b)    This section applies to insurers and nonprofit health service plans that issue or deliver individual or group health insurance policies in the State.    (c)    An entity subject to this section may seek repayment from a health care practitioner of any money paid for a claim, bill, or other demand or request for payment for health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.    (d)    Each individual and group health insurance policy that is issued for delivery in the State by an entity subject to this section and that provides coverage for health care services shall include a provision that excludes payment of any claim, bill, or other demand or request for payment for health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.    (e)    An entity subject to this section shall report to the Commissioner and the appropriate regulatory board any pattern of claims, bills, or other demands or requests for payment submitted for health care services provided as a result of a prohibited referral within 30 days after the entity has knowledge of the pattern.    (f)    (1)    Notwithstanding any other provision of this section, an entity subject to this section that reimburses for health care services is not required to audit or investigate a claim, bill, or other demand or request for payment for health care services to determine whether those services were provided as a result of a prohibited referral.        (2)    An audit or investigation of a claim, bill, or other demand or request for payment for health care services to determine whether those services were provided as a result of a prohibited referral is not grounds to delay payment or waive the provisions of §§ 15–1004 and 15–1005 of this title.    (g)    In accordance with § 1–305 of the Health Occupations Article, an entity subject to this section may seek a refund of a payment made for a claim, bill, or other demand or request for payment that is subsequently determined to be for a health care service provided as a result of a prohibited referral.
MD. Insurance Code Ann. §  15-111 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-111 - Assessment of Fees on Payors

    (a)    Each payor shall cooperate fully in submitting reports and claims data and providing any other information to the Maryland Health Care Commission in accordance with Title 19, Subtitle 1 of the Health - General Article.    (b)    The Commissioner shall report to the Maryland Health Care Commission in a timely manner the name and address of each payor that is assessed a fee under § 19–111 of the Health – General Article.
MD. Insurance Code Ann. §  15-112.3 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-112.3 - Multi-Carrier Common Online Provider Directory Information System

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    (i)    “Carrier” has the meaning stated in § 15–112 of this subtitle.            (ii)    “Carrier” does not include a managed care organization, as defined in Title 15, Subtitle 1 of the Health – General Article.        (3)    “Multi–carrier common online provider directory information system” means the system designated by the Commissioner for use by providers to provide and update their network directory information with carriers.    (b)    The Commissioner may designate a multi–carrier common online provider directory information system developed by a nonprofit alliance of health plans and trade associations if:        (1)    the system is available to providers nationally;        (2)    the system is available to providers at no charge;        (3)    the system allows providers to:            (i)    attest online to the accuracy of their information; and            (ii)    1.    correct any inaccurate information; and                2.    attest to the correction; and        (4)    the nonprofit alliance has a well–established mechanism for outreach to providers.    (c)    A carrier shall accept new and updated network directory information for a provider submitted:        (1)    (i)    through the multi–carrier common online provider directory information system; or            (ii)    directly to the carrier; and        (2)    from:            (i)    the provider;            (ii)    a hospital or academic medical center that:                1.    is a participating provider on the carrier’s provider panel; and                2.    acts as a credentialing intermediary for the carrier for providers that:                A.    participate on the carrier’s provider panel; and                B.    have privileges at the hospital or academic medical center; or            (iii)    any other person that performs credentialing functions on behalf of a provider.
MD. Insurance Code Ann. §  15-114 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-114 - Dental Plans

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan;            (iii)    a health maintenance organization;            (iv)    a dental plan organization; or            (v)    any other person that provides dental benefit plans subject to regulation by the State.        (3)    “Dental point–of–service option” means a delivery system that allows an insured, enrollee, or other covered person under a dental benefit plan to receive dental services outside a provider panel.        (4)    “Provider panel” means the providers that contract with a carrier to provide dental services to the carrier’s insureds, enrollees, or other covered persons under the carrier’s dental benefit plan.    (b)    (1)    If an employer, association, or other private group arrangement offers dental benefit plan coverage to employees or other individuals only through a carrier’s provider panel, the carrier of the employer, association, or other private group arrangement shall offer, or contract with another carrier to offer, a dental point–of–service option to the employer, association, or other private group arrangement as an additional benefit for an employee or other individual, to accept or reject at the employee’s or other individual’s option.        (2)    If a carrier’s dental provider panel is the sole delivery system offered to employees by an employer, the carrier:            (i)    shall offer the employer a dental point–of–service option for the individual employee to accept or reject;            (ii)    may not impose a minimum participation level on the dental point–of–service option; and            (iii)    as part of the group enrollment application, shall provide to each employer a disclosure statement for each dental point–of–service option offered that conforms to regulations, for the point–of–service option required under § 19–710.2 of the Health – General Article, adopted by:                1.    the Maryland Health Care Commission for the small group market; and                2.    the Administration for the non–small group market.    (c)    (1)    An employer, association, or other private group arrangement may require an employee or other individual who accepts the additional coverage under a dental point–of–service option under subsection (b) of this section to pay a premium over the amount of the premium for the dental benefit coverage offered by the carrier only through its provider panel.        (2)    A carrier may impose different cost–sharing provisions for the dental point–of–service option based on whether the dental service is provided through the carrier’s provider panel or outside the carrier’s provider panel.
MD. Insurance Code Ann. §  15-115 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-115 - Provider Participation in Managed Care Organizations

    (a)    (1)    In this section, “carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan;            (iii)    a health maintenance organization;            (iv)    a dental plan organization; or            (v)    any other person that provides health benefit plans subject to regulation by the State.        (2)    “Carrier” includes an entity that arranges a provider panel for a carrier.    (b)    A carrier that operates a managed care organization under Title 15, Subtitle 1 of the Health - General Article may not deny, limit, or otherwise impair the participation of a provider under contract with the carrier for choosing not to participate or limiting participation in the carrier’s managed care organization if the carrier is in violation of § 15-102.5 of the Health - General Article.
MD. Insurance Code Ann. §  15-116 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-116 - Communication of Information by Health Care Providers

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan;            (iii)    a health maintenance organization;            (iv)    a dental plan organization; or            (v)    any other person that provides health benefit plans subject to regulation by the State.        (3)    “Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.    (b)    A carrier, as a condition of a contract with a health care provider or in any other manner, may not prohibit a health care provider from discussing with or communicating to an enrollee, subscriber, public official, or other person information that is necessary or appropriate for the delivery of health care services, including:        (1)    communications that relate to treatment alternatives;        (2)    communications that are necessary or appropriate to maintain the provider-patient relationship while the patient is under the health care provider’s care;        (3)    communications that relate to an enrollee’s or subscriber’s right to appeal a coverage determination of a carrier with which the health care provider, enrollee, or subscriber does not agree; and        (4)    opinions and the basis of an opinion about public policy issues.    (c)    This section does not prohibit a carrier, as a condition of a contract between the carrier and a health care provider, from prohibiting tortious interference with a contract as recognized under State law.
MD. Insurance Code Ann. §  15-117 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-117 - Indemnification of Insurers and Nonprofit Health Service Plans

    (a)    This section applies to insurers and nonprofit health service plans that issue or deliver individual hospital or major medical insurance policies or group or blanket health insurance policies in the State.    (b)    An entity subject to this section, by contract or in any other manner, may not require a health care provider to indemnify the entity or hold the entity harmless from a coverage decision or negligent act of the entity.
MD. Insurance Code Ann. §  15-118 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-118 - Coinsurance Payments for Health Care Services

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Health care service” means a health or medical care procedure or service rendered by a provider that:            (i)    provides testing, diagnosis, or treatment of human disease or dysfunction; or            (ii)    dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.        (3)    “Provider” means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide coverage for health care services to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide coverage for health care services to individuals or groups under contracts that are issued or delivered in the State.    (c)    If an entity subject to this section negotiates and enters into a contract with providers to render health care services to insureds, subscribers, or members at alternative rates of payment, and coinsurance payments are to be based on a percentage of the fee for health care services rendered by a provider, the entity shall calculate the amount of the coinsurance payment to be paid by the insured, subscriber, or member exclusively from the negotiated alternative rate for the health care service rendered.    (d)    An entity subject to this section may not charge or collect from an insured, a subscriber, or a member a coinsurance payment amount that is greater than the amount calculated under subsection (c) of this section.