reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  14-205.3 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 2 - Preferred Provider Organizations|Section 14-205.3 - Assignment of Benefits

    (a)    This section does not apply to on–call physicians or hospital–based physicians.    (b)    An insurer may not:        (1)    prohibit the assignment of benefits to a provider who is a physician by an insured; or        (2)    refuse to directly reimburse a nonpreferred provider who is a physician under an assignment of benefits.    (c)    If an insured has not provided an assignment of benefits, the insurer shall include the following information with the payment to the insured for health care services rendered by the nonpreferred provider who is a physician:        (1)    the specific claim covered by the payment;        (2)    the amount paid for the claim;        (3)    the amount that is the insured’s responsibility; and        (4)    a statement instructing the insured to use the payment to pay the nonpreferred provider in the event the insured has not paid the nonpreferred provider in full for the health care services rendered by the nonpreferred provider.    (d)    If a physician who is a nonpreferred provider seeks an assignment of benefits from an insured, the physician shall provide the following information to the insured, prior to performing a health care service:        (1)    a statement informing the insured that the physician is a nonpreferred provider;        (2)    a statement informing the insured that the physician may charge the insured for noncovered services;        (3)    a statement informing the insured that the physician may charge the insured the balance bill for covered services;        (4)    an estimate of the cost of services that the physician will provide to the insured;        (5)    any terms of payment that may apply; and        (6)    whether interest will apply and, if so, the amount of interest charged by the physician.    (e)    A physician who is a nonpreferred provider shall submit the disclosure form developed by the Commissioner under subsection (f) of this section to document to the insurer the assignment of benefits by an insured.    (f)    The Commissioner shall develop disclosure forms to implement the requirements under subsections (c) and (d) of this section.    (g)    Notwithstanding the provisions of subsection (b) of this section, an insurer may refuse to directly reimburse a nonpreferred provider under an assignment of benefits if:        (1)    the insurer receives notice of the assignment of benefits after the time the insurer has paid the benefits to the insured;        (2)    the insurer, due to an inadvertent administrative error, has previously paid the insured;        (3)    the insured withdraws the assignment of benefits before the insurer has paid the benefits to the nonpreferred provider; or        (4)    the insured paid the nonpreferred provider the full amount due at the time of service.
MD. Insurance Code Ann. §  14-206 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 2 - Preferred Provider Organizations|Section 14-206 - Filings With Commissioner

    (a)    This section applies to an employee benefit plan whose benefit provisions are governed by the Employee Retirement Income Security Act of 1974 (ERISA) or another federal law.    (b)    On request of the Commissioner, each insurer, employer, third party administrator, or other entity that issues, delivers, administers, or offers a preferred provider insurance policy in the State shall file with the Commissioner:        (1)    a written summary description and a prototype copy of:            (i)    the preferred provider insurance policy;            (ii)    all attendant provider service contracts;            (iii)    any other related contracts; and            (iv)    any amendments to the documents listed in items (i) through (iii) of this item; and        (2)    any other related documents or information that the Commissioner requires.    (c)    The Commissioner may impose a penalty not exceeding $1,000 for each failure to comply with this section.
MD. Insurance Code Ann. §  14-401 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-401 - Definitions

    (a)    In this subtitle the following words have the meanings indicated.    (b)    “Dental plan” means a contractual arrangement for dental services.    (c)    “Dental plan organization” means a person that provides directly, arranges for, or administers a dental plan on a prepaid or postpaid individual or group capitation basis.    (d)    “Dental service” means a service included in practicing dentistry as defined in § 4-101 of the Health Occupations Article.    (e)    “Enrollee” means an individual or dependent of the individual who is enrolled in a dental plan.    (f)    “Evidence of coverage” means a contract or certificate that is issued to an enrollee and that specifies the dental services to which the enrollee is entitled.
MD. Insurance Code Ann. §  14-402 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-402 - Scope of Subtitle

    (a)    This subtitle does not apply to:        (1)    a dentist or professional dental corporation that accepts payment on a fee-for-service basis for providing specific dental services to individual patients for whom the services have been prediagnosed;        (2)    an authorized insurer whose activities are authorized and regulated under other provisions of this article;        (3)    a nonprofit health service plan that is subject to Subtitle 1 of this title;        (4)    a health maintenance organization that is authorized by and subject to Title 19, Subtitle 7 of the Health - General Article; or        (5)    a dental plan whose regulation by the State is preempted by federal law.    (b)    In addition to the provisions of this subtitle, dental plan organizations are subject to the provisions of Title 2, Subtitle 5 of this article.
MD. Insurance Code Ann. §  14-403 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-403 - Certificate of Authority Required

    A person may not establish, operate, or administer a dental plan organization or sell, offer to sell, solicit offers to purchase, or receive advance or periodic consideration in conjunction with a dental plan, unless the person has a certificate of authority issued by the Commissioner under this subtitle.
MD. Insurance Code Ann. §  14-404 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-404 - Surplus or Bond

    (a)    Except as provided in subsection (d) of this section, in accordance with this section, a dental plan organization shall have and maintain at all times a surplus equal to the greater of:        (1)    $50,000; or        (2)    2% of the organizations’ annual gross premium income, up to a maximum of the required capital and surplus of a stock insurer under § 4-103 of this article.    (b)    (1)    Except as provided in subsection (d) of this section, a dental plan organization shall deposit with the Commissioner or with any organization or trustee acceptable to the Commissioner through which a custodial or controlled account is used, cash, securities, or any combination of these or other measures that is acceptable to the Commissioner in an amount equal to $25,000 plus 25% of the surplus required in subsection (a) of this section, provided that the deposit shall not be required to exceed $100,000.        (2)    The deposit shall be:            (i)    an admitted asset of the dental plan organization in the determination of surplus;            (ii)    used to protect the interests of the dental plan organization’s enrollees;            (iii)    used to assure continuation of limited health care services to enrollees of a dental plan organization that is in rehabilitation or conservation; and            (iv)    if a dental plan organization is placed in receivership or liquidation, an asset subject to provisions of the Uniform Insurers Liquidation Act.        (3)    All income from deposits shall be an asset of the dental plan organization.        (4)    A dental plan organization may withdraw a deposit or any part thereof after making a substitute deposit of equal amount and value.        (5)    A substitute deposit of any securities is subject to the approval of the Commissioner.    (c)    Except as provided in subsection (d) of this section, the Commissioner may reduce or eliminate the deposit requirement if the dental plan organization has made an acceptable deposit with the State or jurisdiction of domicile for the protection of all enrollees, wherever located, and delivers to the Commissioner a certificate to such effect, duly authenticated by the appropriate State official holding the deposit.    (d)    Subject to subsection (e) of this section, subsections (a), (b), and (c) of this section do not apply to a dental plan organization, so long as the dental plan organization:        (1)    did not have any enrollees as of January 1, 2000;        (2)    held a certificate of authority as of January 1, 2000;        (3)    maintains a current certificate of authority; and        (4)    complies with all applicable laws and regulations, as determined by the Commissioner.    (e)    Subsection (d) of this section does not apply to a dental plan organization that has one or more enrollees on or after January 1, 2000.
MD. Insurance Code Ann. §  14-405 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-405 - Application for Certificate of Authority

    (a)    An applicant for a certificate of authority shall:        (1)    file with the Commissioner an application, verified by an officer or authorized representative of the dental plan organization, on the form that the Commissioner provides; and        (2)    pay to the Commissioner an application fee of $200.    (b)    An application for a certificate of authority shall include:        (1)    the basic organizational documents of the dental plan organization, including the articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, and shareholder agreement;        (2)    all amendments to the organizational documents of the dental plan organization;        (3)    the bylaws, rules and regulations, or similar documents that regulate the conduct or internal affairs of the dental plan organization;        (4)    the names, addresses, and official positions of the individuals who are responsible for conducting the affairs of the dental plan organization, including:            (i)    the members of the board of directors, board of trustees, executive committee, or other governing board or committee;            (ii)    for a corporation, the principal officers; and            (iii)    for a partnership or association, the partners or members;        (5)    each contract made between a dentist and the dental plan organization;        (6)    each contract made between a dentist and an individual listed in item (4) of this subsection, a consultant, or a business manager;        (7)    a description of the dental plan organization and its dental plan or plans, facilities, and personnel;        (8)    the form of evidence of coverage to be issued to enrollees;        (9)    the form of each group contract that is issued to employers, unions, trustees, or others;        (10)    a financial statement that details the assets, liabilities, and sources of financial support for the dental plan organization or, if the financial affairs are audited by an independent certified public accountant, a copy of the most recent regular certified financial statement, unless the Commissioner determines that additional or more recent financial information is required for the proper administration of this subtitle;        (11)    the proposed method of marketing the dental plan, a financial plan with a 3-year projection of the initial operating results, and a statement of the sources of working capital and any other sources of funding;        (12)    if a dental plan organization is not domiciled in the State, an executed power of attorney that appoints the Commissioner as attorney for service of process issued against the dental plan organization in the State;        (13)    a description of the geographic area to be served by the dental plan organization; and        (14)    any other information that the Commissioner requires.
MD. Insurance Code Ann. §  14-406 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-406 - Notice of Modification of Information

    Within 10 days after a significant modification of information submitted with the application for a certificate of authority, a dental plan organization shall file notice of the modification with the Commissioner.
MD. Insurance Code Ann. §  14-407 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-407 - Issuance or Disapproval of Certificate of Authority

    (a)    If the Commissioner is satisfied that the individuals who are responsible for conducting the affairs of the dental plan organization are trustworthy and capable of providing, arranging for, or administering the services offered by the dental plan, the Commissioner shall issue a certificate of authority.    (b)    If the Commissioner disapproves an application for a certificate of authority, the Commissioner shall notify the dental plan organization in writing of the reasons for disapproval.
MD. Insurance Code Ann. §  14-408 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-408 - Term and Renewal of Certificate of Authority

    (a)    A certificate of authority expires on the first June 30 after its effective date unless it is renewed as provided in this section.    (b)    The Commissioner shall renew the certificate of authority of a dental plan organization if the dental plan organization remains in compliance with this subtitle and pays to the Commissioner a renewal fee of $100.
MD. Insurance Code Ann. §  14-410 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-410 - Evidence of Coverage

    (a)    Each enrollee shall receive evidence of coverage that indicates specifically the nature and extent of coverage and the total amount or percentage of payment, if any, that the enrollee must pay for dental services.    (b)    (1)    Except as provided under paragraph (2) of this subsection, a dental plan organization shall issue evidence of coverage to each enrollee of the dental plan organization.        (2)    If an individual enrollee obtains coverage through a policy or through a contract issued by a medical or dental service corporation, the insurer that issued the policy or the medical or dental service corporation shall issue evidence of coverage.    (c)    The dental plan organization, insurer, or medical or dental service corporation may not issue or deliver evidence of coverage or an amendment to evidence of coverage until a copy of the form of evidence of coverage or amendment is filed with and approved by the Commissioner.    (d)    The evidence of coverage shall contain:        (1)    a clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:            (i)    the dental services and the insurance or other benefits, if any, to which enrollees are entitled;            (ii)    any limitations on the services or kind of benefits to be provided, including any charge, deductible, or copayment feature; and            (iii)    where and in what manner information is available about how services may be obtained; and        (2)    a clear and understandable description of the dental plan organization’s method for resolving enrollee complaints.    (e)    A dental plan organization, insurer, or medical or dental service corporation that makes a change in evidence of coverage or the amount or percentage of payment that the enrollee must pay, shall issue to the enrollee evidence of the change in a separate document.
MD. Insurance Code Ann. §  14-411 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-411 - Investigations and Examinations

    (a)    The Commissioner may investigate the business and examine the books, accounts, records, and files of each dental plan organization and to do so shall have reasonably free access to those materials and to the offices and places of business of the dental plan organization.    (b)    (1)    A dental plan organization shall preserve its books, accounts, and records for at least 5 years.        (2)    Preservation by photographic reproduction shall constitute compliance with this subtitle.    (c)    At the discretion of the Commissioner, the Secretary of Health and the State Board of Dental Examiners may participate in investigations and examinations described in this section to verify the solvency of a dental plan organization.    (d)    In an examination under this section, the person examined shall pay the expense incurred by the Commissioner, Secretary of Health, and State Board of Dental Examiners in accordance with § 2–208 of this article.
MD. Insurance Code Ann. §  14-412 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-412 - Complaint System

    (a)    (1)    A dental plan organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees about services of the dental plan organization.        (2)    The dental plan organization shall maintain records of all written complaints initiated by enrollees.    (b)    (1)    The Commissioner may examine the complaint system of a dental plan organization.        (2)    If the Commissioner determines that the complaint system is inadequate, the Commissioner may require a revision of the complaint system.
MD. Insurance Code Ann. §  14-413 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-413 - Annual Report

    (a)    On or before March 1 of each year, each dental plan organization shall file with the Commissioner a complete statement of its financial condition, transactions, and affairs for the immediately preceding calendar year.    (b)    The annual statement shall:        (1)    be in the form and have the content approved for current use by the National Association of Insurance Commissioners or its successor organization; and        (2)    contain any additional information that the Commissioner requires.    (c)    Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an annual statement on or before March 10 shall pay a penalty of:        (1)    $100 for each day from March 1 to March 10, both inclusive; and        (2)    $150 for each day from March 11 to the day before the Commissioner receives the report, both inclusive.    (d)    At any time, the Commissioner may require a dental plan organization doing business in the State to file an interim statement containing the information that the Commissioner considers necessary.    (e)    (1)    Except as provided in paragraph (5) of this subsection, on or before June 1 of each year, each dental plan organization shall file with the Commissioner an audited financial report for the immediately preceding calendar year.        (2)    The dental plan organization shall have the audited financial report prepared by an independent certified public accountant.        (3)    The Commissioner may:            (i)    set requirements for the form and content of the audited financial report; and            (ii)    for good cause, extend the time for filing the audited financial report.        (4)    Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an audited financial report on or before June 10 shall pay a penalty of:            (i)    $100 for each day from June 1 to June 10, both inclusive; and            (ii)    $150 for each day from June 11 to the day before the Commissioner receives the report, both inclusive.        (5)    With 90 days’ advance notice, the Commissioner may require a dental plan organization to file an audited financial report earlier than the date specified in paragraph (1) of this subsection.
MD. Insurance Code Ann. §  14-414 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-414 - Limitation on Use of Income

    A dental plan organization may not use more than 50% of its gross contract and certificate income in any fiscal year for general operating expenses, acquisition expenses, and miscellaneous taxes, licenses, and fees.
MD. Insurance Code Ann. §  14-415 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-415 - Misrepresentation

    (a)    A dental plan organization or its representative may not cause or knowingly allow:        (1)    advertising that is untrue or misleading;        (2)    solicitation that is untrue or misleading; or        (3)    any form of evidence of coverage that is deceptive.    (b)    Unless a dental plan organization holds a certificate of authority as an insurer, the dental plan organization may not use in its name, evidence of coverage, or literature:        (1)    the words “insurance”, “assurance”, “casualty”, “surety”, or “mutual”; or        (2)    any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of an insurer authorized to do business in the State.    (c)    The Commissioner shall enforce this section.    (d)    This subtitle does not limit the powers of the Attorney General and the procedures with respect to consumer fraud.
MD. Insurance Code Ann. §  14-416 (2021)
2021 Maryland Statutes|Insurance|Title 14 - Entities That Act as Health Insurers|Subtitle 4 - Dental Plan Organization Act|Section 14-416 - Cease and Desist Orders

    (a)    The Commissioner may issue an order that directs a dental plan organization or its representative to cease and desist from engaging in an act or practice that violates this subtitle.    (b)    (1)    Within 20 days after service of the cease and desist order, the dental plan organization or its representative may request a hearing to determine whether a violation of this subtitle has occurred.        (2)    A hearing under this subsection shall be conducted in accordance with § 2-213 of this article and is subject to judicial review in accordance with § 2-215 of this article.