ROBERT L. EHRLICH, JR., Governor                             Ch. 461

(i) Statistics on age, sex, and other general demographic data used
to determine the health care needs of its population;

(ii) Identification of the major health problems in the member
population;

(iii) Identification of any special groups of members that have
unique health problems, such as the poor, the elderly, the mentally ill, and
educationally disadvantaged; and

(iv) A description of community health resources and how they will
be used.

(3)     The health maintenance organization shall state its priorities and
objectives in writing, describing how the priorities and objectives relating to the
health problems and needs of the member population will be provided for.

(4)     (i) The health maintenance organization shall provide at the time
membership is solicited a general description of the benefits and services available to
its members, including benefit limitations and exclusions, location of facilities or
providers, and procedures to obtain medical services.

(ii) The health maintenance organization shall place the following
statement, in bold print, on every enrollment card or application: "If you have any
questions concerning the benefits and services that are provided by or excluded under
this agreement, please contact a membership services representative before signing
this application or card".

(5)     The plan shall contain evidence that:

(i) The programs and services offered are based on the health
problems of and the community health services available to its member population;

(ii) There is an active program for preventing illness, disability, and
hospitalization among its members; and

(iii) The services designed to prevent the major health problems
identified among child and adult members and to improve their general health are
provided by the health maintenance organization.

[(e)] (F) (1) The health maintenance organization shall have an internal
peer review system that will evaluate the utilizational services and the quality of
health care provided to its members.

(2) The review system shall:

(i) Provide for review by appropriate health professionals of the
process followed in the provision of health services;

(ii) Use systematic data collection of performances and patient
results;

(iii) Provide interpretation of this data to the practitioners;
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