This title does not apply to: (1) a policy of liability or workers’ compensation and employer’s liability insurance; (2) a group or blanket policy, except as otherwise provided in this title; (3) reinsurance; or (4) a life insurance, endowment, or annuity contract, or contract supplemental to a life insurance, endowment, or annuity contract that contains only those provisions relating […]
In this title, the word “insured” may not be construed to prevent a person other than the insured with a proper insurable interest from applying for and owning a policy covering the insured or from being entitled under that policy to any indemnities, benefits, and rights provided in the policy.
(a) An insurer or nonprofit health service plan may not issue or deliver in the State an individual health insurance policy, or group health insurance policy covering a group of 1,000 lives or less, unless the policy or certificate is: (1) written in simplified language; and (2) approved by the Commissioner as complying with the simplified language standards […]
(a) (1) In this section the following words have the meanings indicated. (2) “Intensive care policy” means a health insurance policy that provides benefits only for treatment received in the specifically designated facility of a hospital that provides the highest level of care and is restricted to patients who are physically and critically ill or injured. (3) “Specified disease […]
(a) (1) In this section the following words have the meanings indicated. (2) “Breast implant” means a pocket or envelope that is surgically inserted under the skin and contains soft silicone gel, saline solution, or a combination of soft silicone gel and saline solution. (3) “Breast implant-related condition” means a condition that the federal Food and Drug Administration recognizes […]
(a) (1) An insurer under a contract that provides an individual with home medical equipment pursuant to an individual, group, or blanket health insurance policy or certificate that is delivered or issued for delivery in the State and that provides benefits on an expense-incurred basis: (i) shall pay the home medical equipment provider directly if the insured has […]
(a) This section applies to insurers and nonprofit health service plans that issue or deliver individual, group, or blanket health insurance policies in the State. (b) At least 30 days before the change is effective, an entity subject to this section that provides pharmaceutical benefits shall notify in writing all pharmacies under contract with the entity of […]
Each insurer that issues or delivers individual, group, or blanket health insurance policies in the State shall establish record keeping procedures that allow review for overutilization and abuse of the use of hospital, health, and medical services that may result from the actions or activities of the policyholders or certificate holders of the insurer or […]
(a) (1) In this section the following words have the meanings indicated. (2) “Loss ratio” means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State. (3) “Specified disease policy” means a health insurance policy that provides: (i) benefits only for a disease or diseases specified in the policy or for […]
(a) (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 […]
(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 […]
(a) (1) In this section the following words have the meanings indicated. (2) “Accredited hospital” has the meaning stated in § 19–301 of the Health – General Article. (3) “Ambulatory surgical facility” has the meaning stated in § 19–3B–01 of the Health – General Article. (4) “Behavioral health care services” has the meaning stated in § 15–127 of this subtitle. […]
(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 […]
(a) (1) In this section the following words have the meanings indicated. (2) “Capitated dental provider panel” means a provider panel for one or more dental plan organizations offering contracts only for dental services reimbursed on a capitated basis for certain services. (3) “Carrier” means: (i) an insurer; (ii) a nonprofit health service plan; (iii) a health maintenance organization; or (iv) a dental […]
(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 […]
(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 practitioner” means an individual who is licensed, certified, or otherwise authorized […]
(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 […]
(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 […]
(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 […]
(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 […]
