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Ch. 243
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2007 Laws of Maryland
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(1) a policy or insurance contract that is issued or delivered in the
State by an insurer, under which health care services are to be provided to the insured
by a preferred provider on a preferential basis; or
(2) another contract that is offered by an employer, third party
administrator, or other entity, under which health care services are to be provided to
the subscriber by a preferred provider on a preferential basis.
(g) "Provider" means a physician, hospital, or other person that is licensed or
otherwise authorized to provide health care services.
(h) "Provider service contract" means a contract between a provider and an
insurer, employer, third party administrator, or other entity, under which the provider
agrees to provide health care services on a preferential basis under specific preferred
provider insurance policies.
(i) "Subscriber" means a person covered for benefits under a preferred
provider insurance policy issued by a person that is not an insurer.
14-202.
(a) (1) This subtitle applies to insurers that issue or deliver individual or
group health insurance policies in the State.
(2) The provisions of this subtitle that apply to insurers also apply to
nonprofit health service plans that issue or deliver individual or group health
insurance policies in the State.
(b) Except as otherwise provided in § 14-206 of this subtitle, this subtitle
does not apply to an employee benefit plan to the extent that the plan is governed by
the Employee Retirement Income Security Act of 1974 (ERISA).
14-203.
The Commissioner may adopt regulations to enforce this subtitle.
14-204.
Subject to the approval of the Commissioner, an insurer may:
(1) offer or administer a health benefit program under which the
insurer offers preferred provider insurance policies that limit, through the use of
provider service contracts, the numbers and types of providers of health care services
eligible for payment as preferred providers; and
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- 1666 -
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