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Martin O'Malley, Governor
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S.B. 427
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(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
(2) establish terms and conditions that providers must meet to qualify
for payment as preferred providers.
14-205.
(a) If a preferred provider insurance policy offered by an insurer provides
benefits for a service that is within the lawful scope of practice of a health-care
provider licensed under the Health Occupations Article, an insured covered by the
preferred provider insurance policy is entitled to receive the benefits for that service
either through direct payments to the health-care provider or through reimbursement
to the insured.
(B) A PREFERRED PROVIDER INSURANCE POLICY OFFERED BY AN
INSURER MAY PROVIDE FOR PAYMENT OF SERVICES RENDERED BY:
(1) PREFERRED PROVIDERS AND NONPREFERRED PROVIDERS;
OR
(2) PREFERRED PROVIDERS.
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- 4241 -
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