PARRIS N. GLENDENING, Governor

Ch. 35

IF THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE NOTIFIES AN
INSURER OR NONPROFIT HEALTH SERVICE PLAN THAT THE DEPARTMENT HAS PAID
FOR OR PROVIDED SERVICES TO AN INDIVIDUAL WHO IS COVERED UNDER AN
INDIVIDUAL, GROUP, OR BLANKET HEALTH INSURANCE POLICY OR CONTRACT
THAT THE INSURER OR NONPROFIT HEALTH SERVICE PLAN ISSUED, DELIVERED, OR
RENEWED IN THE STATE, THE INSURER OR NONPROFIT HEALTH SERVICE PLAN
SHALL REIMBURSE THE DEPARTMENT FOR THE COST OF THE SERVICES,
REGARDLESS OF ANY PROVISION IN THE HEALTH INSURANCE POLICY OR
CONTRACT THAT REQUIRES PAYMENT TO THE POLICYHOLDER, SUBSCRIBER, OR
ANOTHER PAYEE.

(B) LIMITATIONS.

(1) THE BENEFITS PAYABLE TO THE DEPARTMENT OF HEALTH AND
MENTAL HYGIENE UNDER THIS SECTION ARE LIMITED TO THOSE BENEFITS
AVAILABLE UNDER THE TERMS AND CONDITIONS OF THE HEALTH INSURANCE
POLICY OR CONTRACT FOR THE SERVICES PAID FOR OR PROVIDED BY THE
DEPARTMENT.

(2) AN INSURER OR NONPROFIT HEALTH SERVICE PLAN IS NOT
REQUIRED TO MAKE PAYMENT TO THE DEPARTMENT UNDER THIS SECTION IF,
BEFORE RECEIVING NOTICE FROM THE DEPARTMENT UNDER SUBSECTION (A) OF
THIS SECTION, THE INSURER OR NONPROFIT HEALTH SERVICE PLAN HAS PAID THE
BENEFITS AVAILABLE UNDER THE HEALTH INSURANCE POLICY OR CONTRACT IN
GOOD FAITH AND IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE
POLICY OR CONTRACT.

(C) CLAIMS FOR REIMBURSEMENT.

NOTWITHSTANDING ANY OTHER PROVISION OF A HEALTH INSURANCE
POLICY, CONTRACT, OR CERTIFICATE, AN INSURER OR NONPROFIT HEALTH
SERVICE PLAN MAY NOT REFUSE TO REIMBURSE THE DEPARTMENT OF HEALTH
AND MENTAL HYGIENE BECAUSE OF THE MANNER, FORM, OR DATE OF A CLAIM
FOR REIMBURSEMENT IF, WITHIN 2 YEARS AFTER THE DATE OF THE SERVICE FOR
WHICH REIMBURSEMENT IS SOUGHT, THE DEPARTMENT PROVIDES TO THE
INSURER OR NONPROFIT HEALTH SERVICE PLAN SUFFICIENT INFORMATION TO
DETERMINE THE LIABILITY OF THE INSURER OR NONPROFIT HEALTH SERVICE
PLAN.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, §§ 354U, 470N, and 477U.

In subsection (a) of this section, the references to an "individual, group, or
blanket" health insurance policy or contract "that the insurer or nonprofit
health service plan" issued, delivered, or renewed in the State are added to
clarify the applicability of this section.

Also in subsection (a) of this section, the reference to an "individual" covered
under a health insurance policy or contract is substituted for the former
references to a "person" since services can only be provided to an individual
covered under a health insurance policy or contract.

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