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§ 14-205.1. Policies which condition payment on the use of preferred providers

West's Annotated Code of MarylandInsuranceEffective: January 1, 2018

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 14. Entities that Act as Health Insurers
Subtitle 2. Preferred Provider Organizations (Refs & Annos)
Effective: January 1, 2018
MD Code, Insurance, § 14-205.1
§ 14-205.1. Policies which condition payment on the use of preferred providers
Currentness
In general
(a) The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit health service plan does not restrict payment for covered services provided by nonpreferred providers:
(1) for emergency services, as defined in § 19-701 of the Health--General Article;
(2) for an unforeseen illness, injury, or condition requiring immediate care; or
(3) as required under § 15-830 of this article.
Option to include preferred and nonpreferred providers as additional benefit
(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.
Payment of higher premium for additional coverage
(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.

Credits

Added by Acts 2007, c. 243, § 1, eff. Oct. 1, 2007. Amended by Acts 2011, c. 65, § 5, eff. April 12, 2011; Acts 2016, c. 309, § 3, eff. Jan. 1, 2018.
MD Code, Insurance, § 14-205.1, MD INSURANCE § 14-205.1
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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