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2000 LAWS OF MARYLAND
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Ch. 371
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(VII) FIXED INDEMNITY INSURANCE.
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(G) (H) "HEALTH CARE PROVIDER" MEANS:
(1) AN INDIVIDUAL WHO IS LICENSED UNDER THE HEALTH
OCCUPATIONS ARTICLE TO PROVIDE HEALTH CARE SERVICES IN THE ORDINARY
COURSE OF BUSINESS OR PRACTICE OF A PROFESSION AND IS A TREATING PROVIDER
OF THE MEMBER; OR
(2) A HOSPITAL, AS DEFINED IN § 19-301 OF THE HEALTH - GENERAL
ARTICLE.
(H) (1) "HEALTH CARE SERVICE" MEANS A HEALTH OR MEDICAL CARE
PROCEDURE OR SERVICE RENDERED BY A HEALTH CARE PROVIDER THAT:
(1) PROVIDES TESTING, DIAGNOSIS, OR TREATMENT OF A HUMAN
DISEASE OR DYSFUNCTION; OR
(2) DISPENSES DRUGS, MEDICAL DEVICES, MEDICAL APPLIANCES, OR
MEDICAL GOODS FOR THE TREATMENT OF A HUMAN DISEASE OR DYSFUNCTION.
(I)(J)(l) "MEMBER" MEANS A PERSON ENTITLED TO HEALTH CARE BENEFITS
SERVICES UNDER A POLICY, PLAN, OR CERTIFICATE CONTRACT ISSUED OR
DELIVERED IN THE STATE BY A CARRIER
(2) "MEMBER" INCLUDES:
(I) A SUBSCRIBER; AND
(II) UNLESS PREEMPTED BY FEDERAL LAW, A MEDICARE
RECIPIENT.
(3) "MEMBER" DOES NOT INCLUDE A MEDICAID RECIPIENT.
15-10D-O2.
THIS SUBTITLE APPLIES TO A CARRIER FOR ANY CONTRACT THAT;
(1) IS DELIVERED OR ISSUED IN THE STATE; OR
(2) COVERS INDIVIDUALS WHO RESIDE OR WORK IN THE STATE IF THE
CONTRACT IS DELIVERED OR ISSUED IN A STATE THAT THE COMMISSIONER
DETERMINES DOES NOT HAVE AN EXTERNAL COMPLAINT PROCESS FOR APPEALS
COMPARABLE TO THE COMPLAINT PROCESS ESTABLISHED IN THIS SUBTITLE.
15-10D-03.
(A) (1) IN ADDITION TO THE REQUIREMENTS OF SUBTITLE 10A OF THIS
TITLE, EACH CARRIER SHALL ESTABLISH AN INTERNAL APPEAL PROCESS FOR USE
BY ITS MEMBERS AND HEALTH CARE PROVIDERS TO DISPUTE COVERAGE DECISIONS
MADE BY THE CARRIER.
(2) THE CARRIER MAY USE THE INTERNAL GRIEVANCE PROCESS
ESTABLISHED UNDER SUBTITLE 10A OF THIS TITLE TO COMPLY WITH THE
REQUIREMENT OF PARAGRAPH (1) OF THIS SUBSECTION.
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- 2108 -
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