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Ch. 243
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2007 Laws of Maryland
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(2) If the rates for each institutional provider under a preferred
provider insurance policy offered by an insurer vary based on individual negotiations,
geographic differences, or market conditions and are approved by the Health Services
Cost Review Commission, the rates do not constitute unfair discrimination under this
article.
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14-205.1.
(A) THE COMMISSIONER MAY AUTHORIZE AN INSURER OR NONPROFIT
HEALTH SERVICE PLAN TO OFFER A PREFERRED PROVIDER INSURANCE POLICY
THAT CONDITIONS THE PAYMENT OF BENEFITS ON THE USE OF PREFERRED
PROVIDERS IF THE INSURER OR NONPROFIT HEALTH SERVICE PLAN:
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(1) HAS DEMONSTRATED TO THE SECRETARY OF HEALTH AND
MENTAL HYGIENE THAT THE PROVIDER PANEL OF THE INSURER OR
NONPROFIT HEALTH SERVICE PLAN COMPLIES WITH THE REGULATIONS
ADOPTED UNDER § 19-705.1(B)(1)(II) OF THE HEALTH - GENERAL ARTICLE;
AND
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(2) DOES NOT RESTRICT PAYMENT FOR COVERED SERVICES
PROVIDED BY NONPREFERRED PROVIDERS:
(I) FOR EMERGENCY SERVICES, AS DEFINED IN § 19-701 OF
THE HEALTH - GENERAL ARTICLE;
(II) FOR AN UNFORESEEN ILLNESS, INJURY, OR CONDITION
REQUIRING IMMEDIATE CARE; OR
(III) AS REQUIRED UNDER § 15-830 OF THIS ARTICLE.
(A) (B) (1) IF AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE
GROUP ARRANGEMENT OFFERS HEALTH BENEFIT PLAN COVERAGE TO
EMPLOYEES OR INDIVIDUALS ONLY THROUGH PREFERRED PROVIDERS, THEN
THE INSURER OR NONPROFIT HEALTH SERVICE PLAN WITH WHICH THE
EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP ARRANGEMENT IS
CONTRACTING FOR THE COVERAGE SHALL OFFER AN OPTION TO INCLUDE
PREFERRED AND NONPREFERRED PROVIDERS AS AN ADDITIONAL BENEFIT FOR
AN EMPLOYEE OR INDIVIDUAL, AT THE EMPLOYEE'S OR INDIVIDUAL'S OPTION,
TO ACCEPT OR REJECT.
(2) THE INSURER OR NONPROFIT HEALTH SERVICE PLAN SHALL
PROVIDE TO EACH EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT A DISCLOSURE STATEMENT ON THE GROUP APPLICATION THAT
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- 1668 -
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