reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-119 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-119 - Uniform Consultation Referral Forms -- in General

    (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)    An entity subject to this section that requires insureds to have a written referral to receive consultation services shall use the uniform consultation referral form adopted by the Commissioner under § 15–120 of this subtitle as the sole instrument for referrals for consultation services.    (c)    An entity subject to this section may not impose as a condition of coverage a requirement to:        (1)    modify the uniform consultation referral form; or        (2)    submit additional consultation referral forms.    (d)    The uniform consultation referral form:        (1)    shall be properly completed by the health care provider that refers the insured for consultation services; and        (2)    may be transmitted electronically.
MD. Insurance Code Ann. §  15-120 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-120 - Uniform Consultation Referral Forms -- Regulations

    (a)    Subject to subsection (b) of this section, the Commissioner shall adopt by regulation a uniform consultation referral form for use by insurers, nonprofit health service plans, and health maintenance organizations that require insureds or subscribers to have a written referral to receive consultation services.    (b)    The Commissioner may waive the requirements of regulations adopted under subsection (a) of this section for the use of uniform consultation referral forms for an entity that uses the forms solely for internal purposes.    (c)    The Commissioner, in consultation with the Maryland Health Care Commission, shall adopt by regulation standards for the electronic transmission of the data elements contained in the uniform consultation referral form.
MD. Insurance Code Ann. §  15-122 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-122 - Notice of Renewal of Health Benefit Plan

    (a)    In this section, “carrier” means:        (1)    an insurer;        (2)    a nonprofit health service plan;        (3)    a health maintenance organization;        (4)    a dental plan organization; or        (5)    any other person that provides health benefit plans subject to regulation by the State.    (b)    Before renewing a health benefit plan, a carrier shall mail a notice of renewal to the group contract holder at least 45 days before the expiration of the health benefit plan.    (c)    The notice of renewal shall include the dates of the renewal period, the health benefit plan rates, and the terms of coverage under the health benefit plan.
MD. Insurance Code Ann. §  15-122.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-122.1 - Disbursement of Advance Directive Information Sheet by Carriers

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Advance directive” has the meaning stated in § 5–601 of the Health – General Article.        (3)    (i)    “Carrier” means:                1.    an insurer;                2.    a nonprofit health service plan;                3.    a health maintenance organization; and                4.    any other person that provides health benefit plans subject to regulation by the State.            (ii)    “Carrier” does not include a managed care organization.    (b)    A carrier shall provide the advance directive information sheet developed under § 5–615 of the Health – General Article:        (1)    in the carrier’s member publications;        (2)    if the carrier maintains a Web site on the Internet, on the carrier’s Web site; and        (3)    at the request of a member.
MD. Insurance Code Ann. §  15-124 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-124 - Group Health Insurers -- Enrollment of Minors

    (a)    In this section, “group health insurance” has the meaning stated in § 15–301 of this title.    (b)    This section applies to insurers and nonprofit health service plans that issue or deliver group health insurance policies in the State.    (c)    An entity subject to this section when issuing or renewing a group health insurance policy with an employer that does not include dependent coverage shall provide enrollment information to insured employees regarding the methods of enrolling any dependent of an insured employee in the Maryland Children’s Health Program established under § 15-301 of the Health - General Article.
MD. Insurance Code Ann. §  15-125 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-125 - Restrictions on Assigning, Transferring, or Subcontracting Contracts

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    (i)    “Carrier” means:                1.    an insurer;                2.    a nonprofit health service plan;                3.    a health maintenance organization;                4.    a dental plan organization; or                5.    any other person that provides health benefit plans subject to regulation by the State.            (ii)    “Carrier” includes an entity that arranges a provider panel for a carrier.        (3)    “Contract” means the implied or express agreement between a health care provider and carrier, including the rights, obligations, and fee schedule for the provision of health care services.        (4)    “Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.    (b)    (1)    A carrier may not in any manner assign, transfer, or subcontract a health care provider’s contract, wholly or partly, to an insurer that offers personal injury protection coverage under § 19-505 of this article without first informing the health care provider and obtaining the health care provider’s express written consent.        (2)    A carrier may not terminate, limit, or otherwise impair the contract or employment of a health care provider with the carrier on the basis that the health care provider refused to agree to an assignment, transfer, or subcontract of all or part of the health care provider’s contract to an insurer that offers personal injury protection coverage under § 19-505 of this article.    (c)    (1)    A carrier that uses a provider panel for health care services may not require a health care provider, as a condition of participation or continuation on the carrier’s provider panel for health care services, to also serve on a provider panel for workers’ compensation services.        (2)    A carrier may not terminate, limit, or otherwise impair a contract or an agreement with a health care provider, or terminate or limit the employment of a health care provider, based on the health care provider’s election not to serve on a provider panel for workers’ compensation services.        (3)    A carrier shall include in a contract or an agreement with a health care provider a disclosure that informs the health care provider of the right to elect not to serve on a provider panel for workers’ compensation services.
MD. Insurance Code Ann. §  15-126 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-126 - Access to 911 Emergency System

    (a)    In this section, “emergency medical condition” means a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result in:        (1)    placing the patient’s health in serious jeopardy;        (2)    serious impairment to bodily functions; or        (3)    serious dysfunction of any bodily organ or part.    (b)    This section applies to:        (1)    insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups 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)    (1)    An entity subject to this section may not establish or promote an emergency medical response and transportation system that encourages or directs access by an insured or enrollee in competition with or in substitution of the Maryland Emergency Medical Services System (911) or other State, county, or local government emergency medical services system.        (2)    Notwithstanding paragraph (1) of this subsection, an entity subject to this section may use transportation outside the 911 or other government emergency medical services system for services that are not in response to an emergency medical condition.    (d)    An entity subject to this section may not require an insured or enrollee to obtain prior authorization before accessing the 911 system or other State, county, or local government emergency medical services system for an emergency medical condition.    (e)    An entity subject to this section may not use false or misleading language in its enrollment sales materials or in any other materials provided to insureds or enrollees to discourage or prohibit insureds or enrollees from accessing the 911 system for an emergency medical condition.
MD. Insurance Code Ann. §  15-130.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-130.1 - Health Insurance Benefit Cards, Prescription Benefit Cards, and Other Technology

    (a)    This section applies to:        (1)    each health insurer;        (2)    each nonprofit health service plan;        (3)    each health maintenance organization; and        (4)    each managed care organization, as defined in § 15–101 of the Health – General Article.    (b)    Each entity subject to this section shall provide to each insured, subscriber, or enrollee of a policy or contract that meets the definition of minimum essential coverage, as described in 26 C.F.R. § 1.5000a–2, a health insurance benefit card, prescription benefit card, or other technology that indicates which State agency regulates, in whole or in part, the policy or contract offered by the entity by:        (1)    for an entity subject to the Administration, displaying “MIA” prominently; or        (2)    for an entity subject to the Maryland Department of Health, displaying “MDH” prominently.    (c)    This section may not be construed to preclude an entity subject to this section from including:        (1)    any other information required to be included under this article; or        (2)    any information that is in addition to the information required under this section.
MD. Insurance Code Ann. §  15-131 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-131 - Electronic Reimbursement

    (a)    This section applies to:        (1)    insurers and nonprofit health service plans that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under health insurance policies or contracts that are issued or delivered in the State; and        (2)    health maintenance organizations that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under contracts that are issued or delivered in the State.    (b)    If an entity subject to this section requires a pharmacy to submit a request for payment electronically, then the pharmacy or designated agent may choose to be reimbursed electronically, and in that event the entity shall reimburse the pharmacy electronically, and shall provide the appropriate payment data electronically.    (c)    An entity subject to this section may not impose a processing fee for the electronic reimbursement or for providing payment data electronically.
MD. Insurance Code Ann. §  15-132 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-132 - Incentives to Health Care Providers

    (a)    In this section, “carrier” has the meaning stated in § 19–142 of the Health – General Article.    (b)    A carrier shall provide incentives to health care providers in accordance with the requirements of Title 19, Subtitle 1, Part IV of the Health – General Article.
MD. Insurance Code Ann. §  15-133 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-133 - Annual Report

    On or before December 1 of each year, the Commissioner shall report to the General Assembly, in accordance with § 2–1257 of the State Government Article, on the estimated number of insured and self–insured contracts for health benefit plans in the State and the number of insured and self–insured lives under the age of 65 enrolled in benefit plans in the State.
MD. Insurance Code Ann. §  15-134 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-134 - Effect of Federal Patient Protection and Affordable Care Act on Maryland Plans

    (a)    In this section, “grandfathered health plan” has the meaning stated in the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010.    (b)    Except as provided in subsection (c) of this section, a provision of this title or Title 14 of this article enacted after January 1, 2010, may not apply to a group health plan that is a grandfathered health plan or health insurance coverage that is a grandfathered health plan if the provision would prevent the group health plan or health insurance coverage from being considered a grandfathered health plan.    (c)    Subsection (b) of this section does not apply to any provision of this title or Title 14 of this article enacted after January 1, 2010, to enforce a provision of federal law that was enacted on or before January 1, 2010.
MD. Insurance Code Ann. §  15-135 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-135 - Covered Benefits for Annual Preventive Care

    (a)    (1)    In this section, “annual preventive care” means an annual preventive visit, screening, or examination that is a covered benefit under a policy or contract issued or delivered by an entity subject to this section.        (2)    “Annual preventive care” includes, if the service is a covered benefit:            (i)    an annual child wellness visit;            (ii)    a routine gynecological visit;            (iii)    a screening test or examination for colorectal cancer, chlamydia, human papillomavirus, prostate cancer, or breast cancer; and            (iv)    an annual vision visit that includes a vision examination.    (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 or contracts 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 that provides covered benefits for annual preventive care shall provide coverage for the annual preventive care if:        (1)    the annual preventive care is provided no more than once at any time during the plan year established in the policy or contract; and        (2)    any other requirements for coverage of the annual preventive care are met.    (d)    This section may not be construed to require coverage for a service not otherwise required by law.
MD. Insurance Code Ann. §  15-135.1 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-135.1 - Dental Preventive Care Coverage

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization that provides dental benefits on an expense–incurred basis under policies or contracts issued or delivered in the State.        (3)    “Dental preventive care” means a preventive dental visit, screening, oral examination, teeth cleaning (prophylaxis), fluoride treatment, or routine preventive service that is a covered benefit under a policy or contract issued or delivered by a carrier.    (b)    If benefits for dental preventive care are available and all other requirements for the coverage of dental preventive care are met, a carrier shall provide coverage for dental preventive care:        (1)    at any time during the plan year for a policy or contract that provides coverage for dental preventive care once during the plan year; or        (2)    subject to subsection (c) of this section, in accordance with any frequency limitation for a policy or contract that provides coverage for dental preventive care more than once during the plan year.    (c)    A carrier may not impose a frequency limitation on dental preventive care that requires the dental preventive care to be provided at an interval greater than 120 days during a plan year.    (d)    This section may not be construed to require coverage for a service not otherwise required by law.
MD. Insurance Code Ann. §  15-136 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-136 - Bonus Payments to Primary 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; or            (iv)    any other person that provides health benefit plans subject to regulation by the State.        (3)    “Group model health maintenance organization” has the meaning stated in § 19–713.6(a) of the Health – General Article.    (b)    This section applies only to contracts or policies that:        (1)    are issued or delivered by a carrier; and        (2)    provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis.    (c)    (1)    Except as provided in subsection (d) of this section, each carrier shall pay a bonus to primary care providers for services provided in the office:            (i)    after 6 p.m. and before 8 a.m.; or            (ii)    on weekends and national holidays.        (2)    A carrier shall provide for and describe the terms of the bonus payment required in paragraph (1) of this subsection in a separate clause in the carrier’s contract with the primary care provider.    (d)    A group model health maintenance organization is not required to make any bonus payments described in subsection (c) of this section to physicians that are employed by the physician group under contract with the group model health maintenance organization.
MD. Insurance Code Ann. §  15-141 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-141 - Communications Between Carriers and Enrollees -- Confidentiality

    (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)    “Enrollee” means a person entitled to health care benefits from a carrier.    (b)    The Commissioner shall develop and make available a standardized form for an enrollee to use to request confidential communications from a carrier in accordance with 45 C.F.R. § 164.522(b).    (c)    A carrier that requires an enrollee to make a request for confidential communications in writing in accordance with 45 C.F.R. § 164.522(b) shall accept the standardized form developed by the Commissioner under this section for that purpose.    (d)    This section may not be construed to limit acceptance by a carrier of any other form of written request from an enrollee for confidential communications from a carrier under 45 C.F.R. § 164.522(b).
MD. Insurance Code Ann. §  15-143 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 1 - General Provisions|Section 15-143 - Compensation Agreements Arrangements Under Federally Approved Programs and Models

    (a)    In this section, “participation agreement” means a contract that:        (1)    is executed by a payor or program administrator and other participating entities; and        (2)    describes the requirements for participation in a payment model subject to this section.    (b)    This section applies only to a payment model described in § 1–302(d)(12) of the Health Occupations Article:        (1)    that applies to individuals covered under health insurance; and        (2)    under which there is cash compensation.    (c)    (1)    Except as provided in paragraph (2) of this subsection, at least 60 days before an exemption provided under § 1–302(d)(12) of the Health Occupations Article for a payment model subject to this section is implemented, the participation agreement and other documents relevant to the payment model under which a compensation arrangement between a health care practitioner and a health care entity is funded or paid shall be filed with the Commissioner.        (2)    The filing under paragraph (1) of this subsection is not required if the compensation arrangement is funded fully by or paid fully under the Medicare or Medicaid program.    (d)    Within 60 days after the documents required under subsection (c)(1) of this section are filed, the Commissioner shall determine if any compensation arrangement between a health care practitioner and a health care entity funded by or paid under the payment model:        (1)    is insurance business; and        (2)    violates this article or a regulation adopted under this article.    (e)    (1)    If the Commissioner determines that a compensation arrangement is insurance business and violates this article or a regulation adopted under this article, the Commissioner shall issue an order to the filer that specifies the ways in which the compensation arrangement violates this article or a regulation adopted under this article.        (2)    (i)    The Commissioner shall hold a hearing before issuing an order under paragraph (1) of this subsection.            (ii)    The Commissioner shall give written notice of the hearing to the filer at least 10 days before the hearing.            (iii)    The notice shall specify the matters to be considered at the hearing.        (3)    If the compensation arrangement between a health care practitioner and a health care entity changes during its term:            (i)    the filer shall submit a revised filing to the Commissioner for review of the changes; and            (ii)    the Commissioner shall make a new determination, as provided under subsection (d) of this section.    (f)    A filing under subsection (c) of this section is subject to the fee required under § 2–112(a)(13) of this article.