(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. […]
(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 § […]
(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) (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; (v) any person or entity acting as a third party administrator; or (vi) except for a managed care organization as defined in Title 15, Subtitle 1 of the Health – […]
(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 […]
(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 […]
(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; (v) any person or entity acting as a third party administrator; or (vi) except for a managed care organization as defined in Title 15, Subtitle 1 of the Health – […]
(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 […]
(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” […]
(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; […]
(a) (1) In this section the following words have the meanings indicated. (2) (i) “Behavioral health care administrative expenses” means any expenses that are for administrative functions including: 1. billing and collection expenses; 2. accounting and financial reporting expenses; 3. quality assurance and utilization management program or activity expenses; 4. promotion and marketing expenses; 5. taxes, fees, and assessments; 6. legal expenses; 7. salary expenses for […]
(a) (1) In this section the following words have the meanings indicated. (2) “Aggregate attachment point” means the percentage of expected claims in a policy year above which the medical stop–loss insurer assumes all or part of the liability for losses incurred by the insured. (3) “Carrier” means: (i) an insurer; or (ii) a nonprofit health service plan. (4) “Expected claims” means […]
(a) (1) This section applies to: (i) insurers and nonprofit health service plans that provide coverage for prescription drugs on an outpatient basis under health insurance policies or contracts that are issued or delivered in the State; (ii) health maintenance organizations that provide coverage for prescription drugs on an outpatient basis under contracts that are issued or delivered in […]
(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 […]
(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 […]
(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.
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 […]
(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 […]
(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 […]
(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 […]
