WILLIAM DONALD SCHAEFER, Governor Ch. 578

(2) OTHER CONTRACT OFFERED BY AN EMPLOYER,
ADMINISTRATOR, OR OTHER ENTITY THAT SPECIFIES THAT HEALTH
SERVICES COVERED UNDER THE CONTRACT ARE TO BE PROVIDED TO
THE SUBSCRIBER BY A PREFERRED PROVIDER ON A PREFERENTIAL
BASIS.

(H) "PROVIDER" MEANS ANY PERSON, INCLUDING A PHYSICIAN OR
HOSPITAL, WHO IS LICENSED OR OTHERWISE AUTHORIZED TO PROVIDE
HEALTH CARE SERVICES, WITHIN THE SCOPE OF THE LICENSE OR
AUTHORIZATION.

(I) "PROVIDER SERVICE CONTRACT" MEANS A CONTRACT
ENTERED INTO BY A PROVIDER WITH AN INSURER, OR WITH AN
EMPLOYER, AN ADMINISTRATOR, OR OTHER ENTITY, UNDER WHICH
THE PROVIDER UNDERTAKES TO PROVIDE HEALTH CARE SERVICES ON
A PREFERENTIAL BASIS TO INSUREDS OR SUBSCRIBERS UNDER SPECIFIC
PREFERRED PROVIDER INSURANCE POLICIES.

(J) "SUBSCRIBER" MEANS ANY PARTICIPANT IN, SUBSCRIBER TO,
OR BENEFICIARY OF A PREFERRED PROVIDER INSURANCE POLICY
ISSUED BY SOMEONE OTHER THAN AN INSURER.

(K) "UNFAIR DISCRIMINATION" MEANS:

(1) ANY ACT, METHOD OF COMPETITION, OR PRACTICE
ENGAGED IN BY A NONPROFIT HEALTH SERVICE PLAN, WHICH IS
PROHIBITED BY §§ 217 THROUGH 234, INCLUSIVE, OF THIS ARTICLE; OR

(2) ANY ACT, METHOD OF COMPETITION, OR PRACTICE NOT
SPECIFIED IN §§ 217 THROUGH 234, INCLUSIVE, OF THIS ARTICLE THAT
THE COMMISSIONER BELIEVES IS UNFAIR OR DECEPTIVE AND WHICH
RESULTS IN THE INSTITUTION OF AN ACTION BY THE COMMISSIONER
UNDER § 216 OF THIS ARTICLE.

651.

SUBJECT TO THE APPROVAL OF THE COMMISSIONER, AN INSURER

MAY:

(1) OFFER OR ADMINISTER A HEALTH BENEFIT PROGRAM
UNDER WHICH THE INSURER MAY OFFER PREFERRED PROVIDER
INSURANCE POLICIES THAT LIMIT, THROUGH THE USE OF PROVIDER
SERVICE CONTRACTS, THE NUMBERS AND TYPES OF PROVIDERS OF
HEALTH CARE SERVICES ELIGIBLE FOR PAYMENT AS PREFERRED
PROVIDERS; AND

(2) ESTABLISH TERMS AND CONDITIONS THAT SHALL BE MET
BY A PROVIDER TO QUALIFY FOR PAYMENT AS A PREFERRED
PROVIDER.

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