Ch. 35

1997 LAWS OF MARYLAND

In subsection (a)(2) of this section, the former reference to a "profit ... or
mutual" health service plan is deleted for accuracy since no profit or mutual
health service plans exist in the State.

Defined terms: "Health insurance" § 1-101
"Insurer" § 1-101
"Policy" § 1-101

14-203. REGULATIONS.

THE COMMISSIONER MAY ADOPT REGULATIONS TO ENFORCE THIS SUBTITLE.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 659.

The former reference to the Commissioner adopting "necessary" regulations
is deleted as unnecessary in light of the Commissioner's discretion in adopting
regulations.

Defined term: "Commissioner" § 1-101

14-204. AUTHORITY OF INSURERS.

SUBJECT TO THE APPROVAL OF THE COMMISSIONER, AN INSURER MAY:

(1) OFFER OR ADMINISTER A HEALTH BENEFIT PROGRAM UNDER
WHICH THE INSURER OFFERS PREFERRED PROVIDER INSURANCE POLICIES THAT
LIMIT, THROUGH THE USE OF PROVIDER SERVICE CONTRACTS, THE NUMBERS AND
TYPES OF PROVIDERS OF HEALTH CARE SERVICES ELIGIBLE FOR PAYMENT AS
PREFERRED PROVIDERS; AND

(2) ESTABLISH TERMS AND CONDITIONS THAT PROVIDERS MUST MEET
TO QUALIFY FOR PAYMENT AS PREFERRED PROVIDERS.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 656.

Defined terms: "Commissioner" § 1-101
"Insurer" § 1-101
"Preferred provider" § 14-201
"Preferred provider insurance policy" § 14-201
"Provider" § 14-201
"Provider service contract" § 14-201

14-205. BENEFITS FOR HEALTH CARE SERVICES; PAYMENTS TO AND RATES FOR
PROVIDERS.

(A) BENEFITS FOR HEALTH CARE SERVICES.

IF A PREFERRED PROVIDER INSURANCE POLICY OFFERED BY AN INSURER
PROVIDES BENEFITS FOR A SERVICE THAT IS WITHIN THE LAWFUL SCOPE OF
PRACTICE OF A HEALTH CARE PROVIDER LICENSED UNDER THE HEALTH
OCCUPATIONS ARTICLE, AN INSURED COVERED BY THE PREFERRED PROVIDER
INSURANCE POLICY IS ENTITLED TO RECEIVE THE BENEFITS FOR THAT SERVICE

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