PARRIS N. GLENDENING, Governor

Ch. 35

Defined terms: "Authorized insurer" § 1-101
"Commissioner" § 1-101
"Health insurance" § 1-101
"Insurer" § 1-101
"Policy" § 1-101
"Premium" § 1-101

SUBTITLE 7. REQUIRED REIMBURSEMENT FOR SERVICES OF HEALTH CARE

PROVIDERS.

15-701. LICENSED HEALTH CARE PROVIDERS.

(A) IN GENERAL.

(1) THIS SUBSECTION APPLIES TO EACH INDIVIDUAL OR GROUP
HEALTH INSURANCE POLICY, CONTRACT, OR CERTIFICATE THAT IS:

(I) DELIVERED OR ISSUED FOR DELIVERY IN THE STATE BY AN
INSURER OR NONPROFIT HEALTH SERVICE PLAN; AND

(II) ISSUED, RENEWED, AMENDED, OR REISSUED ON OR AFTER

JULY 1. 1984.

(2) NOTWITHSTANDING ANY OTHER PROVISION OF A POLICY,
CONTRACT, OR CERTIFICATE SUBJECT TO THIS SUBSECTION, IF THE POLICY,
CONTRACT, OR CERTIFICATE PROVIDES FOR REIMBURSEMENT FOR A SERVICE
THAT IS WITHIN THE LAWFUL SCOPE OF PRACTICE OF A HEALTH CARE PROVIDER
LICENSED UNDER THE HEALTH OCCUPATIONS ARTICLE, THE INSURED OR ANY
OTHER PERSON COVERED BY OR ENTITLED TO REIMBURSEMENT UNDER THE
POLICY, CONTRACT, OR CERTIFICATE IS ENTITLED TO REIMBURSEMENT FOR THE
SERVICE.

(B) ATTESTING TO SERVICE.

AN INDIVIDUAL OR GROUP DISABILITY INSURANCE POLICY OR CONTRACT
THAT IS DELIVERED OR ISSUED FOR DELIVERY IN THE STATE MAY NOT CONTAIN A
PROVISION THAT PRECLUDES A LICENSED HEALTH CARE PROVIDER FROM
ATTESTING TO THE RENDITION OF SERVICE THAT IS WITHIN THE LAWFUL SCOPE OF
PRACTICE OF THE ATTESTING PROVIDER.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, §§ 490A-1, 354Z(a), 470U(a), and 477AA(a).

In the introductory language of subsection (a)(1) of this section, the former
references to "sickness", "accident", and "disability" insurance are deleted as
unnecessary in light of the comprehensive definition of "health insurance".

Also in the introductory language of subsection (a)(1) of this section, the
former phrase "including profit and nonprofit health plans" is deleted as
unnecessary in light of the reference in subsection (a)(1)(i) of this section to a
policy, contract, or certificate delivered or issued for delivery in the State by a
"nonprofit health service plan".

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