Ch. 445                                    1996 LAWS OF MARYLAND

CHAPTER 445
(House Bill 317)

AN ACT concerning

Health Insurers - Negotiated Alternative Rates - Amount of Insured Copayments

Coinsurance Payment

FOR the purpose of providing that, if certain insurers and nonprofit health service plans
negotiate and enter into contracts with certain health care providers to provide
health care services to their insureds at alternative rates of payment and insured
copayments are to be based on a percentage of the fee for health care services
rendered by a health care provider, the insurer or nonprofit health plan shall
calculate the amount of the copayment coinsurance payment to be paid by an
insured from the negotiated alternative rate; prohibiting insurers and nonprofit
health service plans from charging or collecting copayment amounts coinsurance
payment from an insured that are greater than the copayment coinsurance payment
amount calculated from the negotiated alternative rate; defining certain terms; and
generally relating to requiring insurers and nonprofit health service plans to
calculate insured copayment coinsurance payment amounts from negotiated
alternative rates under certain circumstances.

BY adding to

Article 48A - Insurance Code

Section 490FF

Annotated Code of Maryland

(1994 Replacement Volume and 1995 Supplement)

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article 48A - Insurance Code

490FF.

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

(2)     "HEALTH CARE SERVICE" MEANS ANY HEALTH OR MEDICAL CARE
PROCEDURE OR SERVICE RENDERED BY A PROVIDER THAT:

(I)      PROVIDES TESTING, DIAGNOSIS, OR TREATMENT OF HUMAN
DISEASE OR DYSFUNCTION; OR

(II)     DISPENSES DRUGS, MEDICAL DEVICES, MEDICAL APPLIANCES,
OR MEDICAL GOODS FOR THE TREATMENT OF HUMAN DISEASE OR DYSFUNCTION.

(3)     "PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED, OR
OTHERWISE AUTHORIZED UNDER THE HEALTH OCCUPATIONS ARTICLE TO
PROVIDE HEALTH CARE SERVICES ANY PERSON, INCLUDING A PHYSICIAN OR

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