Ch. 415                                    2004 LAWS OF MARYLAND

[(f)] (I) (G) "Grievance decision" means a final determination by a carrier
that arises from a grievance filed with the carrier under its internal grievance process
regarding an adverse decision concerning a member.

[(g)](J) (H) "Health Advocacy Unit" means the Health Education and
Advocacy Unit in the Division of Consumer Protection of the Office of the Attorney
General established under Title 13, Subtitle 4A of the Commercial Law Article.

[(h)] (K) (I) "Health benefit plan" has the meaning stated in § 2-112.2(a) of
this article.

[(i)] (L) (J) "Health care provider" means:

(1)     an individual who is licensed under the Health Occupations Article to
provide health care services in the ordinary course of business or practice of a
profession and is a treating provider of the member; or

(2)     a hospital, as defined in § 19-301 of the Health - General Article.

[(j)] (M) (K) "Health care service" means a health or medical care procedure
or service rendered by a health care provider that:

(1)     provides testing, diagnosis, or treatment of a human disease or
dysfunction; or

(2)     dispenses drugs, medical devices, medical appliances, or medical
goods for the treatment of a human disease or dysfunction.

[(k)](N) (L) (1) "Member" means a person entitled to health care benefits
under a policy, HEALTH BENEFIT plan, or certificate issued or delivered in the State
by a carrier.

(2)     "Member" includes:

(i) a subscriber; and

(ii) unless preempted by federal law, a Medicare recipient.

(3)     "Member" does not include a Medicaid recipient.

[(l)] (O) (M) "Private review agent" has the meaning stated in § 15-10B-01
of this title.

15-10A-02.

(a) Each carrier shall establish an internal grievance process for its members.

(B) THE CARRIER'S INTERNAL GRIEVANCE PROCESS SHALL ALLOW AN
AUTHORIZED REPRESENTATIVE TO FILE A GRIEVANCE ON BEHALF OF A MEMBER.

[(b)](C) (1) An internal grievance process shall meet the same
requirements established under Subtitle 10B of this title.

(2) In addition to the requirements of Subtitle 10B of this title, an
internal grievance process established by a carrier under this section shall:

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