§ 14-201. Definitions
West's Annotated Code of MarylandInsuranceEffective: July 1, 2011
Effective: July 1, 2011
MD Code, Insurance, § 14-201
§ 14-201. Definitions
(b) “Allowed amount” means the dollar amount that an insurer determines is the value of the health care service provided by a provider before any cost sharing amounts are applied.
(c) “Assignment of benefits” means the transfer of health care coverage reimbursement benefits or other rights under a preferred provider insurance policy by an insured.
(d) “Balance bill” means the difference between a nonpreferred provider's bill for a health care service and the insurer's allowed amount.
(e) “Cost sharing amounts” means the amounts that an insured is responsible for under a preferred provider insurance policy, including any deductibles, coinsurance, or copayments.
(f) “Covered service” means a health care service that is a covered benefit under a preferred provider insurance policy.
(g) “Health care services” has the meaning stated in § 19-701 of the Health--General Article.
(h) “Hospital-based physician” means:
(i) “Insured” means a person covered for benefits under a preferred provider insurance policy offered or administered by an insurer.
(j) “Medicare economic index” means the fixed- weight input price index that:
(k) “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.
(l) “On-call physician” means a physician who:
(m) “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.
(n) “Preferred provider” means a provider that has entered into a provider service contract.
(o) “Preferred provider insurance policy” means:
(p) “Provider” means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services.
(q) “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.
(r) “Similarly licensed provider” means:
Credits
Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 2007, c. 243, § 1, eff. Oct. 1, 2007; Acts 2010, c. 537, § 1, eff. July 1, 2011.
Formerly Art. 48A, § 655.
MD Code, Insurance, § 14-201, MD INSURANCE § 14-201
Current with all legislation from the 2023 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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