Ch. 283                                    1996 LAWS OF MARYLAND

Article - Health - General

19-710.2.

(b) (1) If an employer, association, or other private group arrangement offers
health benefit plan coverage to employees or individuals only through a health
maintenance organization, the health maintenance organization with which the employer,
association, or other private group arrangement is contracting for the coverage shall offer,
or contract with another carrier to offer, a point-of-service option to the employer,
association, or other private group arrangement in conjunction with the health
maintenance organization as an additional benefit for an employee or individual, at the
employee's or individual's option, to accept or reject.

(2) THE EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUT
ARRANGEMENT SHALL MAKE THE POINT-OF-SERVICE OPTION OFFERED BY THE
HEALTH MAINTENANCE ORGANIZATION, OR OTHER CARRIER WITH WHICH THE
HEALTH MAINTENANCE ORGANIZATION CONTRACTED, AVAILABLE TO EACH
EMPLOYEE OR INDIVIDUAL AT THE INITIAL ENROLLMENT PERIOD AND
SUBSEQUENT RENEWAL PERIODS.

(2) (I) EXCEPT FOR HEALTH BENEFIT PLANS SUBJECT TO SUBTITLE 55
OF ARTICLE 48A OF THE CODE, THE HEALTH MAINTENANCE ORGANIZATION SHALL
MAKE THE POINT-OF-SERVICE OPTION AVAILABLE TO EACH ENROLLEE AT THE
INITIAL ENROLLMENT PERIOD AND SUBSEQUENT RENEWAL PERIODS AND INCLUDE
NOTICE OF THE POINT' OF SERVICE OPTION IN EACH EMPLOYEE'S ENROLLMENT
MATERIALS.

(II) A POINT-OF-SERVICE OPTION SHALL BE MADE AVAILABLE
FOR A HEALTH BENEFIT PLAN SUBJECT TO SUBTITLE 55 OF ARTICLE 48A OF THE
CODE IN ACCORDANCE WITH REGULATIONS ADOPTED TO CARRY OUT THAT
SUBTITLE.

(2) WHEN A HEALTH MAINTENANCE ORGANIZATION IS THE SOLE
DELIVERY SYSTEM OFFERED TO EMPLOYEES BY AN EMPLOYER, THE HEALTH
MAINTENANCE ORGANIZATION:

(I) SHALL OFFER THE EMPLOYER A POINT-OF-SERVICE OPTION FOR
THE INDIVIDUAL EMPLOYEE TO ACCEPT OR REJECT;

(II)    MAY NOT IMPOSE A MINIMUM PARTICIPATION LEVEL ON THE
POINT-OF-SERVICE OPTION; AND

(III)   AS PART OF THE GROUP ENROLLMENT APPLICATION SHALL
PROVIDE TO EACH EMPLOYER A DISCLOSURE STATEMENT FOR EACH
POINT-OF-SERVICE OPTION OFFERED THAT CONFORMS TO REGULATIONS, FOR THE
POINT-OF-SERVICE OPTION REQUIRED UNDER PARAGRAPH (1) OF THIS SUBSECTION
ADOPTED BY:

1. THE HEALTH CARE ACCESS AND COST COMMISSION FOR
THE SMALL GROUP MARKET AND

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