Ch. 604

1995 LAWS OF MARYLAND

may not on the average be less than 80 percent of the aggregate payments in that full
calendar year to preferred providers for similar services in the same geographic area
pursuant to the providers' agreements to provide the services under their provider service
agreements.

(4) FOR THE COMPREHENSIVE STANDARD HEALTH BENEFIT PLAN
ESTABLISHED UNDER THE PROVISIONS OF § 700 OF THIS ARTICLE, THE 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 75
PERCENT OF THE AGGREGATE PAYMENTS IN THAT FULL CALENDAR YEAR TO
PREFERRED PROVIDERS FOR SIMILAR SERVICES IN THE SAME GEOGRAPHIC AREA
IN ACCORDANCE WITH THE PROVIDERS' AGREEMENTS TO PROVIDE THE SERVICES
UNDER THEIR PROVIDER SERVICE AGREEMENTS.

Article 48A - Insurance Code

490BB.

(A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.

(2) (I) "CARRIER" MEANS:

(I) 1. AN INSURER;

(II) 2. A NONPROFIT HEALTH SERVICE PLAN;

(III) 3. A HEALTH MAINTENANCE ORGANIZATION;

(IV) A PREFERRED PROVIDER ORGANIZATION;

(V) 4. A DENTAL PLAN ORGANIZATION; OR

(VI) 5. ANY OTHER PERSON OR ORGANIZATION THAT PROVIDES
HEALTH BENEFIT PLANS SUBJECT TO STATE REGULATION.

(II) "CARRIER" INCLUDES AN ENTITY THAT ARRANGES A PROVIDER
PANEL FOR A CARRIER.

(3) "ENROLLEE" MEANS ANY PERSON ENTITLED TO HEALTH CARE
BENEFITS FROM A CARRIER.

(4) "PROVIDER" MEANS A HEALTH CARE PRACTITIONER OR A GROUP
OF HEALTH CARE PRACTITIONERS LICENSED OR OTHERWISE AUTHORIZED BY LAW
TO PROVIDE HEALTH CARE SERVICES.

(5) (I) "PROVIDER PANEL" MEANS THOSE PROVIDERS WITH WHICH A
CARRIER CONTRACTS TO PROVIDE HEALTH CARE SERVICES TO THE CARRIER'S
ENROLLEES UNDER THE CARRIER'S HEALTH BENEFIT PLAN.

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