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Ch. 569
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2000 LAWS OF MARYLAND
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organizations, health insurance policies, including those of nonprofit health service
plans, and with other established programs under which the subscriber or member
may make a claim.
(b) Notwithstanding the provisions of subsection (a) of this section, a contract
between a health maintenance organization and its subscribers or a group of
subscribers may not contain nonduplication provisions or provisions to coordinate
coverage with any individually underwritten and issued, guaranteed renewable,
specified disease policy, as defined in § 15-109 of the Insurance Article, or intensive
care policy, which does not provide benefits on an expense incurred basis.
(c) For purposes of this section, "intensive care policy" means a health
insurance policy that provides benefits only when treatment is received in that
specifically designated facility of a hospital that provides the highest level of care and
which is restricted to those patients who are physically, critically ill or injured.
(D) A CONTRACT BETWEEN A HEALTH MAINTENANCE ORGANIZATION AND ITS
SUBSCRIBERS OR A GROUP OF SUBSCRIBERS MAY CONTAIN A PROVISION OR
PROVISIONS ALLOWING A HEALTH MAINTENANCE ORGANIZATION TO BE
SUBROGATED TO A CAUSE OF ACTION THAT A SUBSCRIBER HAS AGAINST ANOTHER
PERSON TO THE EXTENT THAT ANY PAYMENTS MADE BY THE HEALTH
MAINTENANCE ORGANIZATION OR THE VALUE OF ANY SERVICES PROVIDED BY THE
HEALTH MAINTENANCE ORGANIZATION RESULT FROM THE OCCURRENCE THAT
GAVE RISE TO THE CAUSE OF ACTION.
(D) NOTWITHSTANDING § 19-701(F)(3) OF THIS SUBTITLE. A CONTRACT
BETWEEN A HEALTH MAINTENANCE ORGANIZATION AND ITS SUBSCRIBERS OR A
GROUP OF SUBSCRIBERS MAY CONTAIN A PROVISION ALLOWING THE HEALTH
MAINTENANCE ORGANIZATION TO BE SUBROGATED TO A CAUSE OF ACTION THAT A
SUBSCRIBER HAS AGAINST ANOTHER PERSON:
(1) TO THE EXTENT THAT ANY ACTUAL PAYMENTS MADE BY THE
HEALTH MAINTENANCE ORGANIZATION RESULT FROM THE OCCURRENCE THAT
GAVE RISE TO THE CAUSE OF ACTION; OR
(2) FOR A NONPROFIT HEALTH MAINTENANCE ORGANIZATION THAT
EXCLUSIVELY CONTRACTS WITH A GROUP OF PHYSICIANS TO PROVIDE OR TO
ARRANGE FOR THE PROVISION OF HEALTH CARE SERVICES FOR ITS ENROLLEES, FOR
ANY SERVICE PROVIDED BY THE HEALTH MAINTENANCE ORGANIZATION AS A
RESULT OF THE OCCURRENCE THAT GAVE RISE TO THE CAUSE OF ACTION, PER THE
FEE SCHEDULE ESTABLISHED BY THE NONPROFIT HEALTH MAINTENANCE
ORGANIZATION.
(E) SUBSECTION (D) OF THIS SECTION DOES NOT ALLOW A CONTRACT
BETWEEN A HEALTH MAINTENANCE ORGANIZATION AND ITS SUBSCRIBERS OR A
GROUP OF SUBSCRIBERS TO CONTAIN A PROVISION ALLOWING THE HEALTH
MAINTENANCE ORGANIZATION TO RECOVER ANY PAYMENTS MADE TO A
SUBSCRIBER UNDER A PERSONAL INJURY PROTECTION POLICY.
(F) SUBSECTION (D) OF THIS SECTION DOES NOT ALLOW A HEALTH
MAINTENANCE ORGANIZATION TO RECOVER MEDICAL EXPENSES FROM A
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