PARRIS N. GLENDENING, Governor Ch. 145

(II) EACH YEAR, A CARRIER SHALL:

(1) UPDATE THE DISCLOSURES REQUIRED UNDER SUBSECTION (C) OF
THIS SECTION; AND

(2) FILE THE DISCLOSURES WITH THE COMMISSIONER.

(1) THE COMMISSIONER:

(1) SHALL ESTABLISH A PROCESS FOR:

(I) THE ANNUAL FILING OF THE DISCLOSURES REQUIRED UNDER
SUBSECTION (C) OF THIS SECTION; AND

(II) MAKING THE DISCLOSURES AVAILABLE FOR INSPECTION AND
REVIEW BY THE GENERAL PUBLIC; AND

(2) MAY ADOPT REGULATIONS TO CARRY OUT THIS SECTION.

(J) THE COMMISSIONER MAY ISSUE AN ORDER UNDER § 4-113(D) OF THIS
ARTICLE IF THE COMMISSIONER FINDS A VIOLATION OF THIS SECTION.

(B) THIS SECTION APPLIES TO A CARRIER THAT PROVIDES HEALTH CARE
SERVICES TO ENROLLEES. OR OTHERWISE MAKES HEALTH CARE SERVICES
AVAILABLE TO ENROLLEES. THROUGH CONTRACTS WITH PROVIDERS.

(C) (1) EACH CARRIER SHALL IDENTIFY AND DISCLOSE IN LAYMAN'S
TERMS IN ITS MARKETING ENROLLMENT SALES MATERIALS THE REIMBURSEMENT
METHODOLOGY OR METHODOLOGIES THE CARRIER USES TO REIMBURSE
PHYSICIANS FOR HEALTH CARE SERVICES RENDERED TO ENROLLEES. INCLUDING
CAPITATION. CASE RATES, DISCOUNTED FEE-FOR-SERVICE, AND FEE-FOR-SERVICE
REIMBURSEMENT METHODOLOGIES.

(2) THE HEALTH CARE ACCESS AND COST COMMISSION SHALL
DEVELOP A UNIFORM DEFINITION IN LAYMAN'S TERMS OF EACH REIMBURSEMENT
METHODOLOGY REQUIRED TO BE DISCLOSED AND IDENTIFIED BY CARRIERS
UNDER PARAGRAPH (1) OF THIS SUBSECTION. INCLUDING A REPRESENTATIVE
EXAMPLE OF A TYPICAL CAPITATION ARRANGEMENT BETWEEN A CARRIER AND A
PHYSICIAN.

(D) (1) IN ADDITION TO THE REQUIREMENTS OF SUBSECTION (C)(1) OF THIS
SECTION, EACH CARRIER SHALL DISCLOSE IN ITS MARKETING ENROLLMENT SALES
MATERIALS THE DISTRIBUTION OF EACH $100 IT RECEIVES IN PREMIUM DOLLARS
FROM ENROLLEES FOR THE PRECEDING CALENDAR YEAR FOR WHICH DATA ARE
AVAILABLE.

(2) THE DISCLOSURE REQUIRED UNDER PARAGRAPH (1) OF THIS
SUBSECTION SHALL BE IN THE FORM OF A PIE CHART OR BAR GRAPH WITH
DESCRIPTIVE TERMS AND IN LAYMAN'S TERMS THAT IDENTIFIES CONSISTENT WITH
THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS' HEALTH
MAINTENANCE ORGANIZATION ANNUAL STATEMENT ("ORANGE FORM"):

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