PARRIS N. GLENDENING, Governor

Ch. 35

(1) EXCLUSION OF COVERAGE FOR CLASSES OF DRUGS AS SPECIFIED
BY THE CONTRACT;

(2) CHANGES IN PRIOR OR PREAUTHORIZATION PROCEDURES; OR

(3) SELECTION OF NEW PRESCRIPTION CLAIMS PROCESSORS.
(C) FAILURE TO PROVIDE NOTICE.

AN ENTITY SUBJECT TO THIS SECTION THAT FAILS TO PROVIDE ADVANCE
NOTICE UNDER SUBSECTION (B) OF THIS SECTION SHALL HONOR AND PAY IN FULL
ANY CLAIM UNDER THE PROGRAM RULES OR REQUIREMENTS THAT EXISTED
BEFORE THE CHANGE FOR 30 DAYS AFTER THE POSTMARKED DATE OF THE NOTICE.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, §§ 361H, 468-I, and 476A.

In subsection (a) of this section, the reference to insurers and nonprofit health
service plans "that issue or deliver individual, group, or blanket health
insurance policies in the State" is substituted for the former references to
insurers "under the provisions of this subtitle" to clarify the applicability of
this section.

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

15-108. RECORD KEEPING PROCEDURES.

EACH INSURER THAT ISSUES OR DELIVERS INDIVIDUAL, GROUP, OR BLANKET
HEALTH INSURANCE POLICIES IN THE STATE SHALL ESTABLISH RECORD KEEPING
PROCEDURES THAT ALLOW REVIEW FOR OVERUTILIZATION AND ABUSE OF THE
USE OF HOSPITAL, HEALTH, AND MEDICAL SERVICES THAT MAY RESULT FROM THE
ACTIONS OR ACTIVITIES OF THE POLICYHOLDERS OR CERTIFICATE HOLDERS OF
THE INSURER OR THE PROVIDERS OF HOSPITAL, HEALTH, AND MEDICAL SERVICES
TO THE INSURED INDIVIDUALS.

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

The reference to each insurer "that issues or delivers individual, group, or
blanket health insurance policies in the State" is substituted for the former
references to each insurer "under this subtitle" to clarify the applicability of
this section.

The reference to insured "individuals" is substituted for the former references
to insured "persons" since only an individual can receive hospital, health, and
medical services.

The former phrase "or both" is deleted as surplusage.

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