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PARRIS N. GLENDENING, Governor
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S.B. 164
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Health Insurance - Internal Appeal and Grievance Processes
FOR the purpose of requiring certain carriers to document an adverse decision and to
include certain information in a written notice of an adverse decision to certain
persons; requiring certain carriers to include certain information in a notice of a
grievance decision to certain persons; requiring carriers to establish an internal
appeal process for use by their members and health care providers for disputes
relating to coverage decisions and providing that carriers can comply with this
requirement in a certain manner; requiring carriers to provide certain
information concerning the internal appeal process to members under certain
circumstances; requiring carriers to send members and certain health care
providers written notice of a coverage decision decisions and appeal decisions
within certain time limits under certain circumstances; requiring certain
carriers to include certain information in a notice of a coverage decision;
decisions and appeal decisions; authorizing the Insurance Commissioner to
request authorization to release certain records under certain circumstances;
requiring carriers to meet the burden of persuasion in certain circumstances;
authorizing the Commissioner to consider certain information in reviewing a
complaint; requiring the Commissioner to make and issue a final decision on a
complaint under certain circumstances; requiring the Commissioner to include
certain information in a certain notice to certain persons; providing that a
certain failure of a carrier is a certain violation; authorizing the Commissioner
to take certain action actions against a carrier for certain violations; authorizing
the Commissioner to adopt certain regulations; providing for a delayed effective
date for certain provisions of this Act; making stylistic and technical changes;
defining certain terms; and generally relating to a carrier's internal appeal and
grievance processes.
BY repealing and reenacting, with amendments,
Article - Insurance
Section 15-10A-02(f), (i), (j), and (k)
Annotated Code of Maryland
(1997 Volume and 1999 Supplement)
BY adding to
Article - Insurance
Section 15-10D-01 through 15-10D-05 15-10D-04, inclusive, to be under the
new subtitle "Subtitle 10D. Complaint Process for Coverage Decisions"
Annotated Code of Maryland
(1997 Volume and 1999 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Insurance
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- 3729 -
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