PARRIS N. GLENDENING, Governor

Ch. 35

(B) SCOPE OF SECTION.

THIS SECTION APPLIES TO INSURERS AND NONPROFIT HEALTH SERVICE PLANS
THAT PROVIDE COVERAGE FOR HEALTH CARE SERVICES TO INDIVIDUALS OR
GROUPS ON AN EXPENSE-INCURRED BASIS UNDER HEALTH INSURANCE POLICIES
OR CONTRACTS THAT ARE ISSUED OR DELIVERED IN THE STATE.

(C) CALCULATION OF COINSURANCE PAYMENT AMOUNT.

IF AN ENTITY SUBJECT TO THIS SECTION NEGOTIATES AND ENTERS INTO A
CONTRACT WITH PROVIDERS TO RENDER HEALTH CARE SERVICES TO INSUREDS AT
ALTERNATIVE RATES OF PAYMENT, AND COINSURANCE PAYMENTS ARE TO BE
BASED ON A PERCENTAGE OF THE FEE FOR HEALTH CARE SERVICES RENDERED BY
A PROVIDER, THE ENTITY SHALL CALCULATE THE AMOUNT OF THE COINSURANCE
PAYMENT TO BE PAID BY THE INSURED EXCLUSIVELY FROM THE NEGOTIATED
ALTERNATIVE RATE FOR THE HEALTH CARE SERVICE RENDERED.

(D) LIMITATION ON COINSURANCE PAYMENT AMOUNT.

AN ENTITY SUBJECT TO THIS SECTION MAY NOT CHARGE OR COLLECT FROM
AN INSURED A COINSURANCE PAYMENT AMOUNT THAT IS GREATER THAN THE
AMOUNT CALCULATED UNDER SUBSECTION (C) OF THIS SECTION.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490-11.

In subsection (a)(3) of this section, the former reference to providing health
care services "within the scope of the license or authorization" is deleted as
implicit in the reference to a person "licensed or otherwise authorized" to
provide such services.

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

15-119. UNIFORM REFERRAL FORMS — IN GENERAL.

(A) SCOPE OF SECTION.

THIS SECTION APPLIES TO INSURERS AND NONPROFIT HEALTH SERVICE PLANS
THAT ISSUE OR DELIVER INDIVIDUAL, GROUP, OR BLANKET HEALTH INSURANCE
POLICIES IN THE STATE.

(B) USE OF FORMS.

AN ENTITY SUBJECT TO THIS SECTION THAT REQUIRES INSUREDS TO HAVE A
WRITTEN REFERRAL TO RECEIVE CONSULTATION SERVICES SHALL USE THE
UNIFORM CONSULTATION REFERRAL FORM ADOPTED BY THE COMMISSIONER
UNDER § 15-120 OF THIS SUBTITLE AS THE SOLE INSTRUMENT FOR REFERRALS FOR
CONSULTATION SERVICES.

(C) PROHIBITIONS.

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