H.B. 1042                                               VETOES

(p) (1) Except as provided in paragraph (3) of this subsection, individual
enrollees and subscribers of health maintenance organizations issued certificates of
authority to operate in this State shall not be liable to any health care provider for
any covered services provided to the enrollee or subscriber.

(2)     (i) A health care provider or any representative of a health care
provider may not collect or attempt to collect from any subscriber or enrollee any
money owed to the health care provider by a health maintenance organization issued
a certificate of authority to operate in this State.

(ii) A health care provider or any representative of a health care
provider may not maintain any action against any subscriber or enrollee to collect or
attempt to collect any money owed to the health care provider by a health
maintenance organization issued a certificate of authority to operate in this State.

(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 MEDICARE COPAYMENT OR DEDUCTIBLE OWED BY THE
SUBSCRIBER OR ENROLLEE TO A HEALTH CARE PROVIDER OR A REPRESENTATIVE
OF A HEALTH CARE PROVIDER FOR COVERED SERVICES PROVIDED BY THE HEALTH
CARE PROVIDER WHEN MEDICARE IS THE PRIMARY INSURER AND A HEALTH
MAINTENANCE ORGANIZATION IS THE SECONDARY INSURER; OR

(II) IF MEDICARE IS THE PRIMARY INSURER AND A HEALTH
MAINTENANCE ORGANIZATION IS THE SECONDARY INSURER, ANY AMOUNT UP TO
THE MEDICARE APPROVED OR LIMITING AMOUNT, AS SPECIFIED UNDER THE SOCIAL
SECURITY ACT, THAT IS NOT OWED TO THE HEALTH CARE PROVIDER BY MEDICARE
OR THE HEALTH MAINTENANCE ORGANIZATION AFTER COORDINATION OF
BENEFITS HAS BEEN COMPLETED, FOR MEDICARE COVERED SERVICES PROVIDED TO
THE SUBSCRIBER OR ENROLLEE BY THE HEALTH CARE PROVIDER; OR

[(ii)] (III) Any payment or charges for services that are not covered
services.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take
effect October 1, 2004.

May 26, 2004

The Honorable Michael E. Busch
Speaker of the House
State House
Annapolis, MD 21401

Dear Mr. Speaker:

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