Ch. 605

1995 LAWS OF MARYLAND

(B) IF AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT OFFERS HEALTH BENEFIT PLAN COVERAGE TO EMPLOYEES OR
INDIVIDUALS ONLY THROUGH A HEALTH MAINTENANCE ORGANIZATION, THE
HEALTH MAINTENANCE ORGANIZATION WITH WHICH THE EMPLOYER,
ASSOCIATION, OR OTHER PRIVATE GROUP ARRANGEMENT IS CONTRACTING FOR
THE COVERAGE SHALL OFFER, OR CONTRACT WITH ANOTHER CARRIER TO OFFER,
A POINT-OF-SERVICE OPTION TO THE EMPLOYER, ASSOCIATION, OR OTHER PRIVATE
GROUP ARRANGEMENT IN CONJUNCTION WITH THE HEALTH MAINTENANCE
ORGANIZATION AS AN ADDITIONAL BENEFIT FOR AN EMPLOYEE OR INDIVIDUAL,
AT THE EMPLOYEE'S OR INDIVIDUAL'S OPTION, TO ACCEPT OR REJECT.

(C) (1) AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT MAY REQUIRE AN EMPLOYEE OR INDIVIDUAL THAT ACCEPTS THE
ADDITIONAL COVERAGE UNDER A POINT-OF-SERVICE OPTION UNDER SUBSECTION
(B) OF THIS SECTION TO BE RESPONSIBLE FOR THE PAYMENT OF A PREMIUM OVER
THE AMOUNT OF THE PREMIUM FOR THE COVERAGE OFFERED BY THE HEALTH
MAINTENANCE ORGANIZATION.

(2) A CARRIER MAY IMPOSE DIFFERENT COST-SHARING PROVISIONS
FOR THE POINT-OF-SERVICE OPTION BASED ON WHETHER THE HEALTH CARE
SERVICE IS PROVIDED THROUGH THE PROVIDER PANEL OF THE HEALTH
MAINTENANCE ORGANIZATION OR OUTSIDE THE PROVIDER PANEL OF THE HEALTH
MAINTENANCE ORGANIZATION..

SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read as
follows:

Article 48A - Insurance Code

490DD.

(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 OR ORGANIZATION THAT PROVIDES DENTAL
BENEFIT PLANS SUBJECT TO STATE REGULATION.

(3) "DENTAL POINT-OF-SERVICE OPTION" MEANS A DELIVERY SYSTEM
THAT PERMITS AN INSURED, AN ENROLLEE, OR OTHER COVERED PERSON OF A DENTAL
BENEFIT PLAN TO RECEIVE DENTAL SERVICES OUTSIDE THE PROVIDER PANEL.

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