reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-110 - Prohibited Referrals

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Health care practitioner” has the meaning stated in § 1–301 of the Health Occupations Article.
(3)    “Health care service” has the meaning stated in § 1–301 of the Health Occupations Article.
(4)    “Prohibited referral” means a referral prohibited by § 1–302 of the Health Occupations Article.
(b)    This section applies to insurers and nonprofit health service plans that issue or deliver individual or group health insurance policies in the State.
(c)    An entity subject to this section may seek repayment from a health care practitioner of any money paid for a claim, bill, or other demand or request for payment for health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.
(d)    Each individual and group health insurance policy that is issued for delivery in the State by an entity subject to this section and that provides coverage for health care services shall include a provision that excludes payment of any claim, bill, or other demand or request for payment for health care services that the appropriate regulatory board determines were provided as a result of a prohibited referral.
(e)    An entity subject to this section shall report to the Commissioner and the appropriate regulatory board any pattern of claims, bills, or other demands or requests for payment submitted for health care services provided as a result of a prohibited referral within 30 days after the entity has knowledge of the pattern.
(f)    (1)    Notwithstanding any other provision of this section, an entity subject to this section that reimburses for health care services is not required to audit or investigate a claim, bill, or other demand or request for payment for health care services to determine whether those services were provided as a result of a prohibited referral.
(2)    An audit or investigation of a claim, bill, or other demand or request for payment for health care services to determine whether those services were provided as a result of a prohibited referral is not grounds to delay payment or waive the provisions of §§ 15–1004 and 15–1005 of this title.
(g)    In accordance with § 1–305 of the Health Occupations Article, an entity subject to this section may seek a refund of a payment made for a claim, bill, or other demand or request for payment that is subsequently determined to be for a health care service provided as a result of a prohibited referral.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-111 - Assessment of Fees on Payors

(a)    Each payor shall cooperate fully in submitting reports and claims data and providing any other information to the Maryland Health Care Commission in accordance with Title 19, Subtitle 1 of the Health - General Article.
(b)    The Commissioner shall report to the Maryland Health Care Commission in a timely manner the name and address of each payor that is assessed a fee under § 19–111 of the Health – General Article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-112.1 - Carriers and Credentialing Intermediaries; Uniform Credentialing Form

(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;
5.    a managed care organization; or
6.    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)    “Credentialing intermediary” means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.
(4)    “Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.
(5)    “Provider panel” means the providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.
(6)    “Uniform credentialing form” means the form designated by the Commissioner for use by a carrier or its credentialing intermediary for credentialing and recredentialing a health care provider for participation on a provider panel.
(b)    (1)    Except as provided in subsection (c) of this section, a carrier or its credentialing intermediary shall accept the uniform credentialing form as the sole application for a health care provider to become credentialed or recredentialed for a provider panel of the carrier.
(2)    A carrier or its credentialing intermediary shall make the uniform credentialing form available to any health care provider that is to be credentialed or recredentialed by that carrier or credentialing intermediary.
(c)    The requirements of subsection (b) of this section do not apply to a hospital or academic medical center that:
(1)    is a participating provider on the carrier’s provider panel; and
(2)    acts as a credentialing intermediary for that carrier for health care practitioners that:
(i)    participate on the carrier’s provider panel; and
(ii)    have privileges at the hospital or academic medical center.
(d)    The Commissioner may impose a penalty not to exceed $500 against any carrier for each violation of this section by the carrier or its credentialing intermediary.
(e)    (1)    The Commissioner may adopt regulations to implement the provisions of this section.
(2)    The Commissioner may designate a provider credentialing application developed by a nonprofit alliance of health plans and trade associations for an online credentialing system offered to carriers and providers as the uniform credentialing form if:
(i)    the provider credentialing application is available to providers at no charge; and
(ii)    use of the provider credentialing application is not conditioned on submitting the provider credentialing application to a carrier through the online credentialing system.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-112.3 - Multi-Carrier Common Online Provider Directory Information System

(a)    (1)    In this section the following words have the meanings indicated.
(2)    (i)    “Carrier” has the meaning stated in § 15–112 of this subtitle.
(ii)    “Carrier” does not include a managed care organization, as defined in Title 15, Subtitle 1 of the Health – General Article.
(3)    “Multi–carrier common online provider directory information system” means the system designated by the Commissioner for use by providers to provide and update their network directory information with carriers.
(b)    The Commissioner may designate a multi–carrier common online provider directory information system developed by a nonprofit alliance of health plans and trade associations if:
(1)    the system is available to providers nationally;
(2)    the system is available to providers at no charge;
(3)    the system allows providers to:
(i)    attest online to the accuracy of their information; and
(ii)    1.    correct any inaccurate information; and
2.    attest to the correction; and
(4)    the nonprofit alliance has a well–established mechanism for outreach to providers.
(c)    A carrier shall accept new and updated network directory information for a provider submitted:
(1)    (i)    through the multi–carrier common online provider directory information system; or
(ii)    directly to the carrier; and
(2)    from:
(i)    the provider;
(ii)    a hospital or academic medical center that:
1.    is a participating provider on the carrier’s provider panel; and
2.    acts as a credentialing intermediary for the carrier for providers that:
A.    participate on the carrier’s provider panel; and
B.    have privileges at the hospital or academic medical center; or
(iii)    any other person that performs credentialing functions on behalf of a provider.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-114 - Dental Plans

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan;
(iii)    a health maintenance organization;
(iv)    a dental plan organization; or
(v)    any other person that provides dental benefit plans subject to regulation by the State.
(3)    “Dental point–of–service option” means a delivery system that allows an insured, enrollee, or other covered person under a dental benefit plan to receive dental services outside a provider panel.
(4)    “Provider panel” means the providers that contract with a carrier to provide dental services to the carrier’s insureds, enrollees, or other covered persons under the carrier’s dental benefit plan.
(b)    (1)    If an employer, association, or other private group arrangement offers dental benefit plan coverage to employees or other individuals only through a carrier’s provider panel, the carrier of the employer, association, or other private group arrangement shall offer, or contract with another carrier to offer, a dental point–of–service option to the employer, association, or other private group arrangement as an additional benefit for an employee or other individual, to accept or reject at the employee’s or other individual’s option.
(2)    If a carrier’s dental provider panel is the sole delivery system offered to employees by an employer, the carrier:
(i)    shall offer the employer a dental point–of–service option for the individual employee to accept or reject;
(ii)    may not impose a minimum participation level on the dental point–of–service option; and
(iii)    as part of the group enrollment application, shall provide to each employer a disclosure statement for each dental point–of–service option offered that conforms to regulations, for the point–of–service option required under § 19–710.2 of the Health – General Article, adopted by:
1.    the Maryland Health Care Commission for the small group market; and
2.    the Administration for the non–small group market.
(c)    (1)    An employer, association, or other private group arrangement may require an employee or other individual who accepts the additional coverage under a dental point–of–service option under subsection (b) of this section to pay a premium over the amount of the premium for the dental benefit coverage offered by the carrier only through its provider panel.
(2)    A carrier may impose different cost–sharing provisions for the dental point–of–service option based on whether the dental service is provided through the carrier’s provider panel or outside the carrier’s provider panel.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-115 - Provider Participation in Managed Care Organizations

(a)    (1)    In this section, “carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan;
(iii)    a health maintenance organization;
(iv)    a dental plan organization; or
(v)    any other person that provides health benefit plans subject to regulation by the State.
(2)    “Carrier” includes an entity that arranges a provider panel for a carrier.
(b)    A carrier that operates a managed care organization under Title 15, Subtitle 1 of the Health - General Article may not deny, limit, or otherwise impair the participation of a provider under contract with the carrier for choosing not to participate or limiting participation in the carrier’s managed care organization if the carrier is in violation of § 15-102.5 of the Health - General Article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-116 - Communication of Information by Health Care Providers

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means:
(i)    an insurer;
(ii)    a nonprofit health service plan;
(iii)    a health maintenance organization;
(iv)    a dental plan organization; or
(v)    any other person that provides health benefit plans subject to regulation by the State.
(3)    “Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.
(b)    A carrier, as a condition of a contract with a health care provider or in any other manner, may not prohibit a health care provider from discussing with or communicating to an enrollee, subscriber, public official, or other person information that is necessary or appropriate for the delivery of health care services, including:
(1)    communications that relate to treatment alternatives;
(2)    communications that are necessary or appropriate to maintain the provider-patient relationship while the patient is under the health care provider’s care;
(3)    communications that relate to an enrollee’s or subscriber’s right to appeal a coverage determination of a carrier with which the health care provider, enrollee, or subscriber does not agree; and
(4)    opinions and the basis of an opinion about public policy issues.
(c)    This section does not prohibit a carrier, as a condition of a contract between the carrier and a health care provider, from prohibiting tortious interference with a contract as recognized under State law.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-117 - Indemnification of Insurers and Nonprofit Health Service Plans

(a)    This section applies to insurers and nonprofit health service plans that issue or deliver individual hospital or major medical insurance policies or group or blanket health insurance policies in the State.
(b)    An entity subject to this section, by contract or in any other manner, may not require a health care provider to indemnify the entity or hold the entity harmless from a coverage decision or negligent act of the entity.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-118 - Coinsurance Payments for Health Care Services

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Health care service” means a health or medical care procedure or service rendered by a provider that:
(i)    provides testing, diagnosis, or treatment of human disease or dysfunction; or
(ii)    dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.
(3)    “Provider” means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services.
(b)    This section applies to:
(1)    insurers and nonprofit health service plans that provide coverage for health care services to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
(2)    health maintenance organizations that provide coverage for health care services to individuals or groups under contracts that are issued or delivered in the State.
(c)    If an entity subject to this section negotiates and enters into a contract with providers to render health care services to insureds, subscribers, or members at alternative rates of payment, and coinsurance payments are to be based on a percentage of the fee for health care services rendered by a provider, the entity shall calculate the amount of the coinsurance payment to be paid by the insured, subscriber, or member exclusively from the negotiated alternative rate for the health care service rendered.
(d)    An entity subject to this section may not charge or collect from an insured, a subscriber, or a member a coinsurance payment amount that is greater than the amount calculated under subsection (c) of this section.
2023 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.
2023 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.
2023 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.
2023 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)    to all members or enrollees in initial enrollment materials distributed after initial purchase and upon renewal and in the carrier’s member publications;
(2)    if the carrier maintains a website, on the carrier’s website; and
(3)    at the request of a member.
(c)    If a carrier maintains a website, after the tab on the State–designated health information exchange website required under § 19–145(b)(2)(iv) of the Health – General Article is developed, the carrier shall provide a link to the webpage that is accessed through the tab.
(d)    This section may not be construed to require a carrier to:
(1)    assist a member or enrollee in drafting an electronic advance care planning document;
(2)    store electronic advance care planning documents; or
(3)    access advance care planning documents.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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).
2023 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.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-145 - Definitions -- When Health Savings Account Established

(a)    (1)    In this section the following words having the meanings indicated.
(2)    “Health savings account” has the meaning stated in § 223 of the Internal Revenue Code.
(3)    “High deductible health plan” has the meaning stated in § 223 of the Internal Revenue Code.
(b)    A health savings account is established on the first day that an individual becomes covered by a high deductible health plan.
(c)    The health savings account shall be opened with a trustee or custodian within the time period prescribed by law, without extensions, for filing a federal income tax return for the year in which the health savings account is established.
(d)    A health savings account is established regardless of a transfer of cash or other property to the account and, unless required by the trustee or custodian, it is not necessary for any party to sign a health savings account trust or custodial agreement regarding the health savings account.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1 - General Provisions › Section 15-146 - Conformity With Federal Laws -- the No Surprises Act and Consolidated Appropriations Act, 2021 -- Enforcement

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Blanket health insurance” means the form of health insurance described in § 15–305 of this title.
(3)    “Health benefit plan” means:
(i)    an individual health benefit plan as defined in § 15–1301(o) of this title;
(ii)    a health benefit plan as defined in § 15–1201 of this title; or
(iii)    a health benefit plan as defined in § 15–1401 of this title.
(4)    “Short–term limited duration insurance” has the meaning stated in § 15–1301(s) of this title.
(b)    The provisions of the federal No Surprises Act and Division BB, Title II, § 201 of the federal Consolidated Appropriations Act, 2021, apply to all insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery in the State policies or contracts for a health benefit plan or blanket health insurance.
(c)    The provisions of Division BB, Title II, §§ 202 and 203 of the federal Consolidated Appropriations Act, 2021, apply to all insurers, nonprofit health service plans, and health maintenance organizations that deliver or issue for delivery in the State policies or contracts for a health benefit plan, blanket health insurance, or short–term limited duration insurance.
(d)    The Commissioner may enforce this section under any applicable provisions of this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-01 - Definitions

(a)    In this subtitle the following words have the meanings indicated.
(b)    “Carrier” means:
(1)    an insurer that holds a certificate of authority in the State and provides health insurance in the State;
(2)    a health maintenance organization that is licensed to operate in the State;
(3)    a nonprofit health service plan that is licensed to operate in the State; or
(4)    any other person or organization that provides health benefit plans subject to State insurance regulation.
(c)    “Child” means:
(1)    a natural child, a stepchild, a foster child, or an adopted child of the insured; or
(2)    a child placed with the insured for legal adoption.
(d)    “Essential health benefit” means a health benefit that:
(1)    meets the criteria established under § 1302(b) of the Affordable Care Act; or
(2)    if the Commissioner adopts regulations as described in § 15–1A–04 of this subtitle, meets the criteria established by the adopted regulations.
(e)    “Grandfathered plan” means a health benefit plan that:
(1)    meets the criteria established under 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019; or
(2)    if the Commissioner adopts regulations as described in § 15–1A–03 of the subtitle, meets the criteria established by the adopted regulations.
(f)    “Group plan” means a small group plan or a large group plan.
(g)    “Health benefit plan” means an individual plan, a small group plan, or a large group plan.
(h)    “Individual plan” means an individual health benefit plan as defined in § 15–1301(o) of this title.
(i)    “Insured individual” means:
(1)    an insured, an enrollee, a subscriber, a participant, a member, or a beneficiary of a health benefit plan; or
(2)    any covered dependent of a health benefit plan.
(j)    “Large group plan” means a health benefit plan as defined in § 15–1401 of this title.
(k)    “Small group plan” means a health benefit plan as defined in § 15–1201 of this title.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-02 - Enforcement of Provisions by Commissioner

(a)    The Commissioner may enforce:
(1)    the provisions of this subtitle; and
(2)    notwithstanding any other provisions of law, the following provisions of Title 1, Subtitles A, C, and D of the Affordable Care Act as they apply to individual health insurance coverage and health insurance coverage offered in the small group and large group markets as those terms are defined in the federal Public Health Service Act, issued or delivered in the State by an authorized insurer, nonprofit health service plan, or health maintenance organization:
(i)    coverage of children up to the age of 26 years;
(ii)    preexisting condition exclusions;
(iii)    policy rescissions;
(iv)    bona fide wellness programs;
(v)    lifetime limits;
(vi)    annual limits for essential benefits;
(vii)    waiting periods;
(viii)    designation of primary care providers;
(ix)    access to obstetrical and gynecological services;
(x)    emergency services;
(xi)    summary of benefits and coverage explanation;
(xii)    minimum loss ratio requirements and premium rebates;
(xiii)    disclosure of information;
(xiv)    annual limitations on cost–sharing;
(xv)    child–only plan offerings in the individual market;
(xvi)    minimum benefit requirements for catastrophic plans;
(xvii)    health insurance premium rates;
(xviii)    coverage for individuals participating in approved clinical trials;
(xix)    contract requirements for stand–alone dental plans sold on the Maryland Health Benefit Exchange;
(xx)    guaranteed availability of coverage;
(xxi)    prescription drug benefit requirements; and
(xxii)    preventive and wellness services and chronic disease management.
(b)    The Commissioner may enforce the provisions identified under subsection (a) of this section under any applicable powers granted to the Commissioner under this article.
2023 Maryland Statutes › Insurance › Title 15 - Health Insurance › Subtitle 1A - Consumer Protections › Section 15-1A-03 - Adoption of Regulations -- Application to Health Benefit Plan -- Grandfathered Plans

(a)    For purposes of this subtitle, to the extent necessary, the Commissioner shall adopt regulations that:
(1)    establish criteria that a health benefit plan must meet to be considered a grandfathered plan; and
(2)    are consistent with 45 C.F.R. § 147.140 and any corresponding federal rules and guidance as those provisions were in effect December 1, 2019.
(b)    Except as otherwise provided in this subtitle and subject to subsection (c) of this section, this subtitle applies to any health benefit plan that is offered by a carrier in the State within the scope of:
(1)    Subtitle 12 of this title;
(2)    Subtitle 13 of this title; or
(3)    Subtitle 14 of this title.
(c)    (1)    Except as provided in paragraph (2) of this subsection, the provisions of this subtitle do not apply to a grandfathered plan.
(2)    (i)    The following provisions apply to all grandfathered plans:
1.    the provisions of § 15–1A–08 of this subtitle related to health benefit plans that provide dependent coverage of a child;
2.    the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing lifetime limits on the dollar value of benefits;
3.    the provisions of § 15–1A–12 of this subtitle related to waiting periods;
4.    the provisions of § 15–1A–15 of this subtitle related to summary of benefits and coverage requirements;
5.    the provisions of § 15–1A–16 of this subtitle related to medical loss ratio and corresponding reporting and rebate requirements; and
6.    the provisions of § 15–1A–21 of this subtitle related to rescission of a health benefit plan.
(ii)    The following provisions apply to all grandfathered plans except grandfathered plans that are individual plans:
1.    the provisions of § 15–1A–05 of this subtitle related to preexisting condition exclusions; and
2.    the provisions of § 15–1A–11 of this subtitle related to the prohibition on establishing annual limits on the dollar value of benefits.