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2007 Vetoed Bills and Messages
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S.B. 427
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Article - Insurance
14-201.
(a) In this subtitle the following words have the meanings indicated.
(b) "Insured" means a person covered for benefits under a preferred provider
insurance policy offered or administered by an insurer.
(c) "Nonpreferred provider" means a provider that is eligible for payment
under a preferred provider insurance policy, but that is not a preferred provider under
the applicable provider service contract.
(d) "Preferential basis" means an arrangement under which the insured or
subscriber under a preferred provider insurance policy is entitled to receive health
care services from preferred providers at no cost, at a reduced fee, or under more
favorable terms than if the insured or subscriber received similar services from a
nonpreferred provider.
(e) "Preferred provider" means a provider that has entered into a provider
service contract.
(f) "Preferred provider insurance policy" means:
(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.
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14-202.
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- 4240 -
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