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PARRIS N. GLENDENING, Governor
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Ch. 371
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(2) A NONPROFIT HEALTH SERVICE PLAN;
(3) A HEALTH MAINTENANCE ORGANIZATION;
(4) A DENTAL PLAN ORGANIZATION; OR
(5) EXCEPT FOR A MANAGED CARE ORGANIZATION, AS DEFINED IN
TITLE 15, SUBTITLE 1 OF THE HEALTH - GENERAL ARTICLE, ANY OTHER PERSON
THAT PROVIDES OFFERS A HEALTH CARE SERVICES BENEFIT PLAN SUBJECT TO
REGULATION BY THE STATE.
(E) "COMPLAINT" MEANS A PROTEST FILED WITH THE COMMISSIONER
INVOLVING A COVERAGE DECISION NOT TO PAY A CLAIM FOR HEALTH CARE
SERVICES OTHER THAN THAT WHICH IS COVERED BY SUBTITLE 10A OF THIS TITLE.
(F) (1) "COVERAGE DECISION" MEANS A FINAL AN INITIAL DETERMINATION
BY A CARRIER OR A REPRESENTATIVE OF THE CARRIER THAT RESULTS IN
NONCOVERAGE OF A HEALTH CARE SERVICE.
(2) "COVERAGE DECISION" INCLUDES PAYMENT NONPAYMENT OF ALL
OR ANY PART OF A CLAIM.
(3) "COVERAGE DECISION" DOES NOT INCLUDE AN ADVERSE DECISION
AS DEFINED IN § 15-10A-01(B) OF THIS TITLE.
(G) (1) "HEALTH BENEFIT PLAN" MEANS:
(I) A HOSPITAL OR MEDICAL POLICY OR CONTRACT, INCLUDING A
POLICY OR CONTRACT ISSUED UNDER A MULTIPLE EMPLOYER TRUST OR
ASSOCIATION:
(II) A HOSPITAL OR MEDICAL POLICY OR CONTRACT ISSUED BY A
NONPROFIT HEALTH SERVICE PLAN:
(III) A HEALTH MAINTENANCE ORGANIZATION CONTRACT: OR
(IV) A DENTAL PLAN ORGANIZATION CONTRACT.
(2) "HEALTH BENEFIT PLAN" DOES NOT INCLUDE ONE OR MORE, OR ANY
COMBINATION OF THE FOLLOWING:
(I) LONG-TERM CARE INSURANCE;
(II) DISABILITY INSURANCE:
(III) ACCIDENTAL TRAVEL AND ACCIDENTAL DEATH AND
DISMEMBERMENT INSURANCE;
(IV) CREDIT HEALTH INSURANCE; OR
(V) A HEALTH BENEFIT PLAN ISSUED BY A MANAGED CARE
ORGANIZATION, AS DEFINED IN TITLE 15, SUBTITLE 1 OF THE HEALTH - GENERAL
ARTICLE;
(VI) DISEASE-SPECIFIC INSURANCE; OR
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- 2107 -
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