H.B. 1563

VETOES

(3)      "MANDATED BENEFIT" DOES NOT INCLUDE A STATUTE REQUIRING
REIMBURSEMENT TO A HOSPITAL IN ACCORDANCE WITH THE RATES APPROVED BY
THE STATE HEALTH SERVICES COST REVIEW COMMISSION.

(K) "MEMBER EMPLOYER" MEANS AN EMPLOYER WHO ENROLLS WITH THE
REGIONAL HEALTH COOPERATIVE AND PARTICIPATES IN THE PROGRAM.

(L) "PARTICIPATING CARRIER" MEANS A CARRIER THAT HAS SUBMITTED A
CONTRACT TO THE REGIONAL HEALTH COOPERATIVE TO OFFER HEALTH BENEFIT
PLANS IN ACCORDANCE WITH THIS SUBTITLE.

(M) "PREEXISTING CONDITION" MEANS:

(1)      A CONDITION EXISTING DURING A SPECIFIED PERIOD

IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF COVERAGE THAT WOULD
HAVE CAUSED AN ORDINARILY PRUDENT PERSON TO SEEK MEDICAL ADVICE,
DIAGNOSIS, CARE, OR TREATMENT; OR

(2) A CONDITION FOR WHICH MEDICAL ADVICE, DIAGNOSIS, CARE, OR
TREATMENT WAS RECOMMENDED OR RECEIVED DURING A SPECIFIED PERIOD
IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF THIS COVERAGE.

(N) "PREEXISTING CONDITION PROVISION" MEANS A PROVISION IN A
HEALTH BENEFIT PLAN THAT DENIES, EXCLUDES, OR LIMITS BENEFITS FOR AN
ENROLLEE FOR EXPENSES OR SERVICES RELATED TO A PREEXISTING CONDITION.

(O) "PROGRAM" MEANS THE PROGRAM ESTABLISHED UNDER THIS SUBTITLE
FOR THE OFFER AND PURCHASE OF HEALTH INSURANCE THROUGH REGIONAL
HEALTH COOPERATIVES.

(P) "REGIONAL HEALTH COOPERATIVE" MEANS A REGIONAL HEALTH
COOPERATIVE ESTABLISHED UNDER § 738 OF THIS SUBTITLE.

(Q) "REGIONAL AREA" MEANS ONE OF FOUR CONTIGUOUS GEOGRAPHIC
REGIONS ESTABLISHED BY THE COMMISSIONER AS PROVIDED UNDER § 702 OF THIS
ARTICLE.

(R) "SERVICE AREA" MEANS A PORTION OF A REGIONAL AREA IN WHICH A
HEALTH MAINTENANCE ORGANIZATION IS LICENSED TO OPERATE.

(S) "SUPPLEMENTAL BENEFIT" MEANS A COMMUNITY RATED BENEFIT
OFFERED UNDER A HEALTH CARE PLAN THAT;

(1) DOES NOT DUPLICATE ANY OF THE BENEFITS IN THE
COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN;

(2) INCREASES ACCESS TO CARE CHOICES, INCREASES THE FREQUENCY
WITH WHICH SERVICES MAY BE OBTAINED, OR LOWERS THE UNIFORM COST
SHARING ARRANGEMENTS DESCRIBED IN THE COMPREHENSIVE STANDARD
HEALTH BENEFIT PLAN;

(3) IS PRICED SEPARATELY FROM THE COMPREHENSIVE STANDARD
HEALTH BENEFIT PLAN; AND

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