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Martin O'Malley, Governor S.B. 427
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(2) DOES NOT RESTRICT PAYMENT FOR COVERED SERVICES
PROVIDED BY NONPREFERRED PROVIDERS:
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(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
AN OPTION TO INCLUDE PREFERRED AND NONPREFERRED PROVIDERS IS
AVAILABLE FOR THE INDIVIDUAL OR EMPLOYEE TO ACCEPT OR REJECT.
(B)(C) AN EMPLOYER, ASSOCIATION, OR OTHER PRIVATE GROUP
ARRANGEMENT MAY REQUIRE AN EMPLOYEE OR INDIVIDUAL THAT ACCEPTS
THE ADDITIONAL COVERAGE FOR PREFERRED AND NONPREFERRED PROVIDERS
TO PAY A PREMIUM GREATER THAN THE AMOUNT OF THE PREMIUM FOR THE
COVERAGE OFFERED FOR PREFERRED PROVIDERS ONLY.
15-112.
(b) (1) A carrier that uses a provider panel shall:
(i) 1. if the carrier is an insurer, nonprofit health service
plan, or dental plan organization, maintain standards in accordance with regulations
adopted bv the Commissioner for availability of health care providers to meet the
health care needs of enrollees; [and]
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- 4243 -
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