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§ 15-1007. Summary explanation of benefits

West's Annotated Code of MarylandInsuranceEffective: April 8, 2014

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 10. Claims and Utilization Review (Refs & Annos)
Effective: April 8, 2014
MD Code, Insurance, § 15-1007
§ 15-1007. Summary explanation of benefits
Currentness
Application of section
(a) This section applies to insurers and nonprofit health service plans that propose to issue or deliver individual, group, or blanket health insurance policies or contracts or to administer health benefit programs that provide hospital, medical, or surgical benefits on an expense-incurred basis.
Annual summary provided to insured individuals
(b) Each entity subject to this section shall provide to an insured individual who has filed a claim described in subsection (c) of this section an annual summary explanation of benefits that covers the preceding 12-month period.
Contents of summary
(c) The summary explanation of benefits required under subsection (b) of this section shall provide a summary of:
(1) all claims filed by health care providers for services rendered to the insured individual or covered dependent of the insured individual during an inpatient hospitalization or an outpatient surgical procedure;
(2) the amount paid by the entity for each claim filed; and
(3) the balance owed by the insured individual for each claim filed.
Construction with regulations
(d) The explanation of benefits required under this section is subject to 45 C.F.R. § 164.522(b).

Credits

Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 2014, c. 72, § 1, eff. April 8, 2014.
Formerly Art. 48A, §§ 354LL, 470BB, 477LL.
MD Code, Insurance, § 15-1007, MD INSURANCE § 15-1007
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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