ROBERT L. EHRLICH, JR., Governor                             Ch. 440

1. THE HEALTH MAINTENANCE ORGANIZATION OF THE
MEMBER OR SUBSCRIBER; OR

2. A PROVIDER UNDER WRITTEN CONTRACT WITH THE
HEALTH MAINTENANCE ORGANIZATION OF THE MEMBER OR SUBSCRIBER; OR

(III) PREAUTHORIZED OR OTHERWISE APPROVED EITHER
VERBALLY OR IN WRITING BY:

1. THE HEALTH MAINTENANCE ORGANIZATION OF THE
MEMBER OR SUBSCRIBER; OR

2. A PROVIDER UNDER WRITTEN CONTRACT WITH THE
HEALTH MAINTENANCE ORGANIZATION OF THE MEMBER OR SUBSCRIBER

19-710.

(p) (3) Notwithstanding any other provision of this subsection, a health care
provider or representative of a health care provider may collect or attempt to collect
from a subscriber or enrollee:

(i) Any copayment or coinsurance sums owed by the subscriber or
enrollee to a health maintenance organization issued a certificate of authority to
operate in this State for covered services provided by the health care provider; or

(ii) Any payment or charges for services [not covered under the
subscriber's contract] THAT ARE NOT COVERED SERVICES.

SECTION 3. AND BE IT FURTHER ENACTED, That the Laws of Maryland
read as follows:

Article - Health - General

19-710.1.

(a) (1) In this section the following words have the meanings indicated.

(2)     "Enrollee" means a subscriber or member of the health maintenance
organization.

(3)     ["Covered service" means a health care service included in the
benefit package of the health maintenance organization and rendered to an enrollee
of the health maintenance organization by a health care provider, including a
physician or hospital, not under written contract with the health maintenance
organization.

(4)] "Adjunct claims documentation" means an abstract of an enrollee's
medical record which describes and summarizes the diagnosis and treatment of, and
services rendered to, the enrollee, including, in the case of trauma rendered in a
trauma center, an operative report, a discharge summary, a Maryland Ambulance
Information Systems form, or a medical record.

[(5)] (4) "Institute" means the Maryland Institute for Emergency
Medical Services Systems.

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