WILLIAM DONALD SCHAEFER, Governor

Ch. 394

X-ray, emergency, and preventive services, out-of-area coverage,
and any other health care services that the Commissioner
determines to be available generally on an insured or prepaid
basis in the area serviced by the health maintenance
organization, and, at the option of the health maintenance
organization, may provide additional coverage;

(3)  Except for any copayment or deductible
arrangement, is compensated only on a predetermined periodic rate
basis for providing to members the minimum services that are
specified in item (2) of this subsection;

(4)  Assures its subscribers and members, the
Commissioner, and the Department that one clearly specified legal
and administrative focal point or element of the health
maintenance organization has the responsibility of providing the
availability, accessibility, quality, and effective use of
comprehensive health care services; and

(5)  Primarily provides services of physicians:

(i) Directly through physicians who are either
employees or partners of the health maintenance organization; or

(ii) Under arrangements with one or more groups
of physicians, who are organized on a group practice or
individual practice basis, under which each group:

1.  Is compensated for its services
primarily on the basis of an aggregate fixed sum or on a per
capita basis; and

2.  Is provided with an effective
incentive to avoid unnecessary inpatient use, whether the
individual physician members of the group are paid on a
fee-for-service or other basis.

19-710.

(d) (1) The health maintenance organization shall be
actuarially sound.

(2) (i) Except as otherwise provided in this
paragraph, the stock or surplus that the health maintenance
organization is required to have shall be paid in full.

(ii) The health maintenance organization shall
have stock or A surplus that exceeds the liabilities of the
health maintenance organization [by either] IN AN AMOUNT THAT IS
AT LEAST EQUAL TO THE GREATER OF [$100,000] $250,000 or 5
percent of the subscription charges earned during the prior
calendar year as recorded in the annual report filed by the
health maintenance organization with the Commissioner.

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