reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-109 - Delivery of Policy or Certificate to Debtor

(a)    Except as otherwise provided in this section, the individual policy or group certificate of credit life insurance, credit health insurance, or credit involuntary unemployment benefit insurance shall be delivered to the insured debtor when the indebtedness is incurred.
(b)    (1)    If the individual policy or group certificate is not delivered to the debtor when the indebtedness is incurred, a copy of the application for the policy or a notice of proposed insurance shall be delivered to the debtor when the indebtedness is incurred.
(2)    The application for the policy or notice of proposed insurance shall:
(i)    be signed by the debtor;
(ii)    include:
1.    the name and home office address of the insurer;
2.    the name of the insured debtor;
3.    the premium or amount of payment, if any, paid by the debtor shown separately for credit life insurance, credit health insurance, and credit involuntary unemployment benefit insurance;
4.    a brief description of the coverage, including the amount and term of the coverage; and
5.    a statement that the proposed insurance becomes effective under § 13-107 of this title on acceptance by the insurer;
(iii)    refer exclusively to insurance coverage; and
(iv)    be separate from the loan, sale, or other credit statement of account, instrument, or agreement, unless that document sets forth prominently the information required by this paragraph.
(3)    If the insurer accepts the insurance, within 30 days after the date the indebtedness is incurred, the insurer shall cause the individual policy or group certificate to be delivered to the debtor.
(c)    If the named insurer does not accept the risk:
(1)    the debtor shall receive an individual policy or group certificate that sets forth the name and home office address of the substituted insurer, if any, and the amount of the premium to be charged; and
(2)    an appropriate refund shall be made if the amount of the premium charged by the substituted insurer is less than the premium set forth in the notice of proposed insurance.
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-112 - Refunds

(a)    (1)    Subject to paragraph (3) of this subsection, each individual policy or group certificate shall provide that any refund of the amount paid by the debtor for credit life insurance, credit health insurance, or credit involuntary unemployment benefit insurance will be paid or credited promptly to the person entitled to it if the insurance is terminated before the scheduled maturity date of the indebtedness.
(2)    The formula to be used in computing a refund shall be filed with and approved by the Commissioner.
(3)    The Commissioner shall establish a minimum refund, below which an insurer need not make a refund.
(b)    If a creditor requires a debtor to make a payment for credit life insurance, credit health insurance, or credit involuntary unemployment benefit insurance and an individual policy or group certificate is not issued, the creditor immediately shall give written notice to the debtor and promptly shall make an appropriate credit to the debtor’s account.
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-113 - Claims

(a)    (1)    A claimant shall report a claim promptly to the insurer or its designated claim representative.
(2)    The insurer shall maintain adequate claim files.
(3)    The insurer shall settle a claim as soon as possible and in accordance with the terms of the insurance contract.
(b)    The insurer shall pay a claim by a draft drawn on the insurer or by a check of the insurer to the order of:
(1)    the claimant to whom payment of the claim is due under the policy; or
(2)    a person to whom the claimant directs payment be made.
(c)    (1)    A plan or arrangement may not be used if it authorizes a person other than the insurer or its designated claim representative to settle or adjust claims.
(2)    The creditor may not be designated as the claim representative of the insurer to adjust a claim.
(3)    Notwithstanding paragraph (2) of this subsection, by arrangement with the group insurer, a group policyholder may draw a draft or check in payment of a claim due to the group policyholder subject to audit and review by the group insurer.
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-114 - Option of Debtor to Provide Insurance

(a)    (1)    If a creditor requires credit life insurance, credit health insurance, or credit involuntary unemployment benefit insurance as additional security for an indebtedness, the debtor may:
(i)    provide the required coverage through existing policies that the debtor owns or controls; or
(ii)    procure and provide the required coverage through any authorized insurer.
(2)    At any time during the credit transaction by giving notice to the creditor, the debtor may choose to provide the required coverage.
(b)    (1)    On consummation of a credit transaction in which a creditor requires as additional security for an indebtedness, and a debtor agrees to buy, credit life insurance, credit health insurance, or credit involuntary unemployment benefit insurance, the creditor shall notify the debtor in writing of the option referred to in subsection (a) of this section.
(2)    The debtor shall acknowledge in writing that the debtor has received notice under paragraph (1) of this subsection.
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-116 - Fronting Agreements

(a)    An authorized insurer that issues coverage under this title may not engage in fronting agreements with unauthorized insurers with respect to any insurance written or issued in the State under which the authorized insurer by reinsurance or otherwise transfers to one or more unauthorized insurers:
(1)    substantially the entire risk of loss under substantially all of the insurance written by the authorized insurer in the State;
(2)    all of a kind, line, type, or class of insurance;
(3)    all of the business produced through an insurance producer or agency;
(4)    all of the business in a designated geographical area; or
(5)    all of the business written on a policy form.
(b)    (1)    This section does not apply to an unauthorized insurer if the unauthorized insurer:
(i)    files an annual statement with the Commissioner in accordance with § 4–116 of this article;
(ii)    maintains reserves on its life insurance and health insurance business in accordance with § 5–203 and Title 5, Subtitle 3 of this article;
(iii)    meets the requirements of Title 5, Subtitles 1 through 5 of this article with regard to the valuation of its assets and liabilities;
(iv)    allows examination by the Commissioner in accordance with §§ 2–205 through 2–209 of this article; and
(v)    has maintained on its behalf security on deposit with the Commissioner equal to the amount by which the capital and surplus required of an authorized insurer under §§ 4–104 and 4–105 of this article exceeds the actual capital and surplus of the unauthorized insurer.
(2)    The security required under paragraph (1)(v) of this subsection may consist of:
(i)    cash;
(ii)    an irrevocable letter of credit issued by a bank domiciled in the State that may be terminated only after 30 days’ written notice sent by certified mail or electronic means in accordance with § 2–116 of this article to the Commissioner;
(iii)    obligations, valued at the lower of market value or par value, that are general obligations of, or obligations guaranteed by, the federal government, the State, or a political subdivision of the State; or
(iv)    any other type of security that would be acceptable to the Commissioner if posted by a domestic insurer or foreign insurer.
2023 Maryland Statutes › Insurance › Title 13 - Credit Life, Health, and Involuntary Unemployment Benefit Insurance › Section 13-117 - Enforcement of Title

(a)    After notice and hearing, the Commissioner may adopt regulations to carry out this title.
(b)    If the Commissioner finds that an insurer or other person authorized or licensed by the Commissioner has violated this title or a regulation adopted under this title, then after written notice and a hearing, the Commissioner shall:
(1)    set forth the details of the findings; and
(2)    issue an order for compliance by a specified date.
(c)    An order issued under subsection (b) of this section binds the insurer or other person authorized or licensed by the Commissioner on the date specified unless:
(1)    the Commissioner withdraws the order before the specified date; or
(2)    a court of competent jurisdiction orders a stay of the order of the Commissioner.
(d)    (1)    A party to a proceeding under this title that is aggrieved by an order of the Commissioner is entitled to judicial review in accordance with § 2-215 of this article.
(2)    The filing of an appeal from the withdrawal of approval of a form or rate previously in use operates as a stay, unless the court determines otherwise.
(e)    In addition to any other penalty provided by law, on proof satisfactory to the court, the court may impose on an insurer or other person that violates a final order of the Commissioner while the order is in effect a civil penalty not exceeding $250, or if the violation is willful, a civil penalty not exceeding $1,000.
(f)    (1)    After notice and a hearing, the Commissioner may suspend or revoke the license, certificate of authority, or certificate of qualification of an insurer or other person that violates a final order of the Commissioner.
(2)    The order for suspension or revocation is subject to judicial review in accordance with § 2-215 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part I - Definitions; General Provisions › Section 14-101 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Health care provider” means a chiropractor, dentist, hospital, optometrist, pharmacist, physician, podiatrist, or psychologist.
(c)    “Health care services” means chiropractic, dental, hospital, medical, optometric, pharmaceutical, podiatric, or psychological services.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part I - Definitions; General Provisions › Section 14-104 - Statement of Principal Claims Practices

(a)    Each nonprofit health service plan that provides hospital benefits shall furnish a statement of the plan’s principal claims practices as part of the certificate form or booklet describing the coverage to be afforded.
(b)    The statement shall include practices for payment for:
(1)    surgical procedures performed by two or more surgeons;
(2)    services provided in-area by nonparticipating providers; and
(3)    services provided out-of-area by affiliated plans and affiliated providers.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part I - Definitions; General Provisions › Section 14-105 - Fraudulent Health Insurance Claims

(a)    If a nonprofit health service plan is successful in an action against a person authorized to provide health care in the State, the nonprofit health service plan may recover the costs and expenses reasonably incurred by it in the action if it shows that:
(1)    the person knowingly or willfully made or caused to be made:
(i)    a false statement or representation of a material fact in an application for a benefit or payment from a nonprofit health service plan under this subtitle or Title 15 of this article;
(ii)    a false statement or representation of a material fact for use in determining rights to those benefits or payments; or
(iii)    a false statement or representation about a procedure, operation, or service alleged to have been performed; or
(2)    the person:
(i)    engaged in gross, willful, and continued overcharging for a procedure, operation, or service; or
(ii)    filed false statements for collection of fees for services that were not rendered.
(b)    If a nonprofit health service plan is denied relief in an action under this section, the person against whom the action was brought may recover the costs and expenses reasonably incurred by the person in defending the action.
(c)    This section does not limit any additional rights or remedies that a nonprofit health service plan may have at law or in equity.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part I - Definitions; General Provisions › Section 14-106.1 - Transfers of Funds to Certain Nonprofit Health Service Plans

Beginning in fiscal year 2006, a nonprofit health service plan shall transfer funds in the amounts provided under § 14–106(d)(2) of this subtitle to:
(1)    the Community Health Resources Commission Fund established under § 19–2201 of the Health – General Article to support the costs of the Community Health Resources Commission as provided in § 14–106(d)(1)(v) of this subtitle;
(2)    the Maryland Department of Health for the Kidney Disease Program under Title 13, Subtitle 3 of the Health – General Article; and
(3)    the Maryland Department of Health for the provision of mental health services to the uninsured under Title 10, Subtitle 2 of the Health – General Article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part I - Definitions; General Provisions › Section 14-107 - Transfer of Excess Surplus to Senior Prescription Drug Assistance Program -- Satisfaction of Requirements; Penalties; Hearing

(a)    By November 1 of each year, the Commissioner shall issue an order notifying each nonprofit health service plan that is required to file a report under § 14–106 of this subtitle of whether the plan has satisfied the requirements of § 14–106 of this subtitle.
(b)    If the Commissioner determines that a nonprofit health service plan has not satisfied the requirements of § 14–106 of this subtitle, the Commissioner shall issue an order requiring the nonprofit health service plan to pay the premium tax under Title 6, Subtitle 1 of this article:
(1)    for a period of time beginning with the date the plan was determined to be out of compliance with § 14–106 of this subtitle; and
(2)    in an amount equal to the amount by which the value of the nonprofit health service plan’s premium tax exemption under § 6–101(b) of this article exceeds the sum of:
(i)    the subsidy required under the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health – General Article; and
(ii)    other funds used by the nonprofit health service plan to meet the public service requirement under § 14–106 of this subtitle.
(c)    A nonprofit health service plan that fails to timely file the report required under § 14–106 of this subtitle shall pay the penalties under § 14–121 of this subtitle.
(d)    A party aggrieved by an order of the Commissioner issued under this section has a right to a hearing in accordance with §§ 2–210 through 2–215 of this article.
(e)    Premium tax revenue collected by the Administration as the result of an order issued under subsection (b) of this section shall be deposited into the Senior Prescription Drug Assistance Program Fund established under § 15–1004 of the Health – General Article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part II - Certificates of Authority › Section 14-109 - Applications for Certificate of Authority

An applicant for a certificate of authority shall:
(1)    file with the Commissioner an application on the form that the Commissioner provides containing the information that the Commissioner considers necessary;
(2)    pay to the Commissioner the applicable fee required by § 2-112 of this article; and
(3)    file with the Commissioner copies of the following documents, certified by at least two of the executive officers of the corporation:
(i)    articles of incorporation, including the applicant’s corporate mission statement, with all amendments;
(ii)    bylaws with all amendments;
(iii)    each contract executed or proposed to be executed by the corporation and a health care provider, embodying the terms under which health care services are to be furnished to subscribers to the plan;
(iv)    each form of contract issued or proposed to be issued to subscribers to the plan and a table of the rates charged or proposed to be charged to subscribers for each form of contract;
(v)    a financial statement of the corporation, including the amount of each contribution paid or agreed to be paid to the corporation for working capital, the name of each contributor, and the terms of each contribution;
(vi)    a list of the names and addresses of and biographical information about the members of the board of directors of the corporation;
(vii)    a list of the total compensation paid or proposed to be paid to each officer and member of the board of directors of the corporation;
(viii)    a list of the beginning and ending terms of membership for each member of the board of directors of the corporation; and
(ix)    any other information or documents that the Commissioner considers necessary to ensure compliance with this subtitle.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part II - Certificates of Authority › Section 14-110 - Issuance of Certificate of Authority

(a)    The Commissioner shall issue a certificate of authority to an applicant if:
(1)    the applicant has paid the applicable fee required by § 2-112 of this article; and
(2)    the Commissioner is satisfied:
(i)    that the applicant has been organized in good faith for the purpose of establishing, maintaining, and operating a nonprofit health service plan that:
1.    is committed to a nonprofit corporate structure;
2.    in accordance with the charter of the nonprofit health service plan, seeks to provide affordable and accessible health insurance; and
3.    in accordance with the charter of the nonprofit health service plan, recognizes a responsibility to contribute to the improvement of the overall health status of the residents of the jurisdictions in which it operates;
(ii)    that:
1.    each contract executed or proposed to be executed by the applicant and a health care provider to furnish health care services to subscribers to the nonprofit health service plan, obligates or, when executed, will obligate each health care provider party to the contract to render the health care services to which each subscriber is entitled under the terms and conditions of the various contracts issued or proposed to be issued by the applicant to subscribers to the plan; and
2.    each subscriber is entitled to reimbursement for podiatric, chiropractic, psychological, or optometric services, regardless of whether the service is performed by a licensed physician, licensed podiatrist, licensed chiropractor, licensed psychologist, or licensed optometrist;
(iii)    that:
1.    each contract issued or proposed to be issued to subscribers to the plan is in a form approved by the Commissioner; and
2.    the rates charged or proposed to be charged for each form of each contract are fair and reasonable;
(iv)    that the applicant has a surplus, as defined in § 14-117 of this subtitle, of the greater of:
1.    $100,000; and
2.    an amount equal to that required under § 14-117 of this subtitle; and
(v)    that, except for a nonprofit health service plan that insures between 1 and 10,000 covered lives in the State, the nonprofit health service plan’s corporate headquarters is located in the State.
(b)    If the Commissioner determines that a nonprofit health service plan does not continue to satisfy the requirements of this subtitle, the Commissioner may disapprove the renewal of the certificate of authority of the nonprofit health service plan.
(c)    The Commissioner shall consider an entity’s inability to comply with the requirements of § 14-102(c) of this subtitle as a result of a conflict with the legislatively enacted charter of the entity or the laws or administrative rules or regulations of the jurisdiction of domicile of the entity in determining whether to issue or renew a certificate of authority under this section.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part II - Certificates of Authority › Section 14-111 - Scope of Certificate of Authority

Subject to the authority of the Commissioner to regulate nonprofit health service plans under this article, a certificate of authority issued under this subtitle authorizes a corporation to:
(1)    issue contracts in the form filed with the Commissioner to persons that become subscribers to the plan;
(2)    finance capital improvement projects through the Maryland Health and Higher Educational Facilities Authority as provided under Title 10, Subtitle 3 of the Economic Development Article;
(3)    finance capital improvement projects through the Maryland Economic Development Corporation as provided under Title 10, Subtitle 1 of the Economic Development Article; and
(4)    partner with the State and other public or private entities to provide services or administer programs intended to address community health care needs.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part II - Certificates of Authority › Section 14-112 - Revocation of Certificate of Authority and Institution of Delinquency Proceedings

The Commissioner may revoke a certificate of authority issued to a corporation subject to this subtitle, and at any time after revocation may institute proceedings under Title 9, Subtitle 2 of this article to rehabilitate or liquidate the corporation, if:
(1)    grounds exist under § 4-113 of this article; or
(2)    the Commissioner has reason to believe that the corporation:
(i)    is being operated for profit;
(ii)    is being fraudulently conducted;
(iii)    is not complying with this subtitle or article;
(iv)    knowingly is failing to comply with a rule, regulation, or order of the Commissioner; or
(v)    has violated the provisions of Title 6.5 of the State Government Article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part III - Management, Finances, and Solvency › Section 14-115.1 - Duties of Officers; Sanctions

(a)    In this section, “officer” means any officer that a Maryland corporation is required or permitted to have under § 2-412 of the Corporations and Associations Article.
(b)    (1)    An officer of a nonprofit health service plan shall act:
(i)    in good faith;
(ii)    in a manner that is reasonably believed to be in the best interests of the corporation and its controlled affiliates or subsidiaries that offer health benefit plans;
(iii)    in a manner that is consistent with the mission of a nonprofit health service plan as required under § 14-102(c) of this subtitle; and
(iv)    with the care that an ordinarily prudent person in a like position would use under similar circumstances.
(2)    Except for the receipt of reasonable remuneration in conformity with § 14-139 of this subtitle, an officer of a nonprofit health service plan may not use the position of officer for personal or financial enrichment.
(3)    A violation of this subsection shall be considered an unsound or unsafe business practice under § 14-116 of this subtitle.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part III - Management, Finances, and Solvency › Section 14-118 - Impaired Surplus

(a)    If the minimum surplus of a corporation authorized under this subtitle required to be maintained by § 14-117 of this subtitle becomes impaired, the Commissioner immediately may determine the amount of deficiency and serve notice on the corporation and its board of directors to cure the deficiency within the time period specified by the Commissioner, which may not exceed 120 days after service of the notice.
(b)    The corporation may cure the deficiency in cash or in assets eligible for the investment of the corporation’s funds under § 14-120 of this subtitle.
(c)    Except as provided in subsection (d) of this section, if a corporation that has been notified of a deficiency under subsection (a) of this section does not cure the deficiency and file proof that it has done so with the Commissioner within the time period specified by the Commissioner:
(1)    the corporation may be considered insolvent; and
(2)    the Commissioner may institute delinquency proceedings against the corporation under Title 9, Subtitle 2 of this article.
(d)    (1)    The corporation may apply for a single extension of not more than 60 days to cure a deficiency.
(2)    The Commissioner may grant the extension if:
(i)    the corporation shows good cause why the deficiency was not cured in the initial time period specified by the Commissioner; and
(ii)    the deficiency exists because the Commissioner required an increased surplus, disallowed certain assets, or reduced the value of certain assets carried in the corporation’s accounts.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part III - Management, Finances, and Solvency › Section 14-119 - Notification of Impairment

(a)    In addition to the requirements of § 9-231 of this article, if a chief executive officer, chief financial officer, treasurer, or director knows that a nonprofit health service plan or its affiliate or subsidiary is impaired, that individual immediately shall notify the Commissioner of the impairment, unless the Commissioner has already been notified of the impairment by the chief executive officer, chief financial officer, treasurer, or director.
(b)    The provisions of § 9-231(d), (f), and (g) of this article apply to notice provided to the Commissioner under this section.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part III - Management, Finances, and Solvency › Section 14-120 - Investments

(a)    In this section, “group health care” means a practice by which an affiliate or subsidiary of a nonprofit health service plan engages the services of health care specialists who provide health care at predetermined locations in accordance with a prepaid health plan.
(b)    (1)    Except as provided in paragraph (2) of this subsection, a corporation subject to this subtitle may invest its funds only in assets allowed for the investment of the funds of life insurers under §§ 5-101 and 5-102 and Title 5, Subtitle 5 of this article.
(2)    If the Commissioner determines that a corporation subject to this subtitle is engaged principally in the business of group health care rather than the sale of an insurance product or plan described in § 14-102 of this subtitle, the Commissioner may allow the corporation to invest a sum not to exceed 50% of its assets in real estate for use as medical facilities and fixed medical equipment to be used solely for the purpose of engaging in group health care.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part IV - Regulatory Authority of Commissioner › Section 14-125 - Inspection and Examination

(a)    The Commissioner or an examiner of the Administration may inspect and examine the affairs of a corporation authorized under this subtitle and an affiliate or subsidiary of a corporation authorized under this subtitle.
(b)    In conducting an inspection or examination under this section, the Commissioner or examiner:
(1)    shall have free access to all of the books and documents of the corporation and its affiliates or subsidiaries; and
(2)    may subpoena and examine under oath any person, including an officer, agent, or employee of the corporation or its affiliates and subsidiaries, in relation to the affairs, transactions, and condition of the corporation or its affiliates and subsidiaries.
(c)    The Commissioner may delegate the authority provided under this section to a designee of the Commissioner.
(d)    The corporation or its affiliate or subsidiary whose affairs are examined under this section shall pay the expenses of examination in accordance with § 2-208 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part IV - Regulatory Authority of Commissioner › Section 14-127 - Judicial Review

(a)    Each decision or finding of the Commissioner about rates and forms made under § 14-126 of this subtitle is subject to judicial review in accordance with Title 11, Subtitle 5 of this article.
(b)    All other decisions and findings of the Commissioner about a corporation subject to this subtitle are subject to judicial review in accordance with § 2-215 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part VI - Prohibited Acts; Penalties › Section 14-136 - Unfair and Discriminatory Trade Practices; Other Prohibited Acts

(a)    Nonprofit health service plans are subject to Title 27 of this article.
(b)    A corporation authorized under this subtitle that maintains or operates a nonprofit health service plan may not:
(1)    deny a claim made under a contract, certificate, or policy of a nonprofit health service plan for an unfair or unfairly discriminatory reason;
(2)    without just cause, require a person making a claim under a contract, certificate, or policy of a nonprofit health service plan to accept less than the amount due; or
(3)    fail to notify in writing a subscriber or certificate holder of a nonprofit health service plan of a denial of a properly completed claim within 60 days after the plan receives the claim.
(c)    If it appears to the Commissioner that an act or practice or proposed act or practice of a corporation authorized under this subtitle that maintains or operates a nonprofit health service plan is in violation of subsection (b) of this section or Title 27 of this article, the burden of persuasion is on the corporation to show that the act or practice or proposed act or practice is not in violation of subsection (b) of this section or Title 27 of this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part VI - Prohibited Acts; Penalties › Section 14-137 - Exclusion of Coverage for Violations

A nonprofit health service plan may not issue, renew, or deliver an individual or group contract in the State that excludes coverage for hospital or medical expenses based on a violation of:
(1)    a provision of Title 21 of the Transportation Article; or
(2)    a provision of the Natural Resources Article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 1 - Nonprofit Health Service Plans › Part VI - Prohibited Acts; Penalties › Section 14-140 - Prohibited Acts; Criminal Penalties

(a)    (1)    A person may not engage in the business of operating a nonprofit health service plan unless the person has a certificate of authority issued by the Commissioner under this subtitle.
(2)    A person that violates this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $50,000 for each violation.
(b)    (1)    A person may not:
(i)    violate a provision of this subtitle; or
(ii)    make a willfully false statement in a written document required by this subtitle to be filed with the Commissioner.
(2)    A person that violates this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 for each violation or imprisonment not exceeding 1 year or both.
(c)    A person that willfully makes a false statement while under an oath administered by the Commissioner or designee of the Commissioner at an investigation or hearing conducted by the Commissioner or designee of the Commissioner is guilty of perjury.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 2 - Preferred Provider Organizations › Section 14-202 - Scope of Subtitle

(a)    (1)    This subtitle applies to insurers that issue or deliver individual or group health insurance policies in the State.
(2)    The provisions of this subtitle that apply to insurers also apply to nonprofit health service plans that issue or deliver individual or group health insurance policies in the State.
(b)    Except as otherwise provided in § 14-206 of this subtitle, this subtitle does not apply to an employee benefit plan to the extent that the plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA).
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 2 - Preferred Provider Organizations › Section 14-204 - Authority of Insurers

Subject to the approval of the Commissioner, an insurer may:
(1)    offer or administer a health benefit program under which the insurer offers preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers; and
(2)    establish terms and conditions that providers must meet to qualify for payment as preferred providers.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 2 - Preferred Provider Organizations › Section 14-205 - Benefits for Health Care Services; Payments to and Rates for Providers

(a)    If a preferred provider insurance policy offered by an insurer provides benefits for a service that is within the lawful scope of practice of a health care provider licensed under the Health Occupations Article, an insured covered by the preferred provider insurance policy is entitled to receive the benefits for that service either through direct payments to the health care provider or through reimbursement to the insured.
(b)    (1)    A preferred provider insurance policy offered by an insurer under this subtitle shall provide for payment of services rendered by nonpreferred providers as provided in this subsection.
(2)    Unless the insurer demonstrates to the satisfaction of the Commissioner that an alternative level of payment is more appropriate, for each covered service under a preferred provider insurance policy, the difference between the coinsurance percentage applicable to nonpreferred providers and the coinsurance percentage applicable to preferred providers may not be greater than 20 percentage points.
(3)    If the preferred provider insurance policy contains a provision for the insured to pay the balance bill, the provision may not apply to an on–call physician or a hospital–based physician who has accepted an assignment of benefits in accordance with § 14–205.2 of this subtitle.
(4)    The insurer’s allowed amount for a health care service covered under the preferred provider insurance policy provided by nonpreferred providers may not be less than the allowed amount paid to a similarly licensed provider who is a preferred provider for the same health care service in the same geographic region.
(c)    (1)    In this subsection, “unfair discrimination” means an act, method of competition, or practice engaged in by an insurer:
(i)    that is prohibited by Title 27, Subtitle 2 of this article; or
(ii)    that, although not specified in Title 27, Subtitle 2 of this article, the Commissioner believes is unfair or deceptive and that results in the institution of an action by the Commissioner under § 27–104 of this article.
(2)    If the rates for each institutional provider under a preferred provider insurance policy offered by an insurer vary based on individual negotiations, geographic differences, or market conditions and are approved by the Health Services Cost Review Commission, the rates do not constitute unfair discrimination under this article.
2023 Maryland Statutes › Insurance › Title 14 - Entities That Act as Health Insurers › Subtitle 2 - Preferred Provider Organizations › Section 14-205.1 - Option to Include Preferred or Nonpreferred Providers

(a)    The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit health service plan does not restrict payment for covered services provided by nonpreferred providers:
(1)    for emergency services, as defined in § 19–701 of the Health – General Article;
(2)    for an unforeseen illness, injury, or condition requiring immediate care; or
(3)    as required under § 15–830 of this article.
(b)    (1)    If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through preferred providers, then the insurer or nonprofit health service plan with which the employer, association, or other private group arrangement is contracting for the coverage shall offer an option to include preferred and nonpreferred providers as an additional benefit for an employee or individual, at the employee’s or individual’s option, to accept or reject.
(2)    The insurer or nonprofit health service plan shall provide to each employer, association, or other private group arrangement a disclosure statement on the group application that an option to include preferred and nonpreferred providers is available for the individual or employee to accept or reject.
(c)    An employer, association, or other private group arrangement may require an employee or individual that accepts the additional coverage for preferred and nonpreferred providers to pay a premium greater than the amount of the premium for the coverage offered for preferred providers only.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.