HARRY HUGHES, Governor

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qualify for payment as a preferred provider under the insurance
policies or insurance contracts.

(3)  If a preferred provider policy or preferred
provider contract provides for reimbursement for any service that
is within the lawful scope of practice of a health care provider
licensed under the Health Occupations Article, any participant,
beneficiary, or other person covered by the insurance policy or
insurance contract shall be entitled to reimbursement for that
service.

(4) (I) Preferred provider policies or preferred
provider contracts offered under this section shall provide for
payment of services rendered by nonpreferred providers. Unless
the nonprofit health service plan demonstrates to the
satisfaction of the Insurance Commissioner that an alternative
level of payment is more appropriate under the circumstances, any
payment AGGREGATE PAYMENTS IN ANY FULL CALENDAR YEAR made under
this paragraph TO NONPREFERRED PROVIDERS AFTER ALL DEDUCTIBLE AND
COPAYMENT PROVISIONS HAVE BEEN APPLIED may not ON THE AVERAGE be
less than 80% of the amount that would have been paid AGGREGATE
PAYMENTS IN THAT FULL CALENDAR YEAR to preferred providers for
similar services In the same geographic area PURSUANT TO THE
PREFERRED PROVIDERS' AGREEMENTS TO PROVIDE THE SERVICES.

(II) ALL COPAYMENT AND DEDUCTIBLE PROVISIONS
CONTAINED IN PREFERRED PROVIDER POLICIES OR PREFERRED PROVIDER
CONTRACTS OFFERED UNDER THIS SECTION WHICH ARE APPLICABLE TO

CLAIMS FOR PAYMENT FOR SERVICES RENDERED BY NONPREFERRED

PROVIDERS SHALL BE THE SAME AS THE COPAYMENT AND DEDUCTIBLE
PROVISIONS APPLICABLE TO CLAIMS FOR PAYMENT FOR SIMILAR SERVICES
RENDERED BY PREFERRED PROVIDERS.

470X.

(b) (1) Subject to the approval of the Commissioner, an
insurer, including any nonprofit health service plan specified
under Subtitle 20 of this article, may offer or administer a
health benefit program under which the insurer may offer
preferred provider policies or preferred provider contracts that
limit the numbers and types of providers of health care services
eligible for payment as preferred providers under the insurance
policies or insurance contracts.

(2)  An insurer may establish terms and conditions
that shall be met by a provider in order to qualify for payment
as a preferred provider under the insurance policies or insurance
contracts.

(3)  If a preferred provider policy or preferred
provider contract provides for reimbursement for any service that
is within the lawful scope of practice of a health care provider
licensed under the Health Occupations Article, any participant,
beneficiary, or other person covered by the insurance policy or