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Subtitle 1 - Nonprofit Health Service Plans
Part I - Definitions; General Provisions
Section 14-101 - Definitions - (a) In this subtitle the following words have the meanings...
Section 14-102 - Nonprofit Health Service Plans - (a) The purpose of this subtitle is: (1) to regulate...
Section 14-103 - Disclosure of Nonprofit Status - Each nonprofit health service plan shall disclose on each document,...
Section 14-104 - Statement of Principal Claims Practices - (a) Each nonprofit health service plan that provides hospital benefits...
Section 14-105 - Fraudulent Health Insurance Claims - (a) If a nonprofit health service plan is successful in...
Section 14-106 - Premium Tax Exemption Report -- in General - (a) It is the public policy of this State that...
Section 14-106.1 - Transfers of Funds to Certain Nonprofit Health Service Plans - Beginning in fiscal year 2006, a nonprofit health service plan...
Section 14-107 - Transfer of Excess Surplus to Senior Prescription Drug Assistance Program -- Satisfaction of Requirements; Penalties; Hearing - (a) By November 1 of each year, the Commissioner shall...
Part II - Certificates of Authority
Section 14-108 - Certificate of Authority Required - A corporation subject to this subtitle may not issue contracts...
Section 14-109 - Applications for Certificate of Authority - An applicant for a certificate of authority shall: (1) file...
Section 14-110 - Issuance of Certificate of Authority - (a) The Commissioner shall issue a certificate of authority to...
Section 14-111 - Scope of Certificate of Authority - Subject to the authority of the Commissioner to regulate nonprofit...
Section 14-112 - Revocation of Certificate of Authority and Institution of Delinquency Proceedings - The Commissioner may revoke a certificate of authority issued to...
Part III - Management, Finances, and Solvency
Section 14-115 - Management of Business by Board of Directors - (a) (1) In this section the following words have the...
Section 14-115.1 - Duties of Officers; Sanctions - (a) In this section, “officer” means any officer that a...
Section 14-116 - Unsound or Unsafe Business Practices - (a) (1) In this section, “unsound or unsafe business practice”...
Section 14-117 - Surplus Requirements - (a) (1) In this section the following words have the...
Section 14-118 - Impaired Surplus - (a) If the minimum surplus of a corporation authorized under...
Section 14-119 - Notification of Impairment - (a) In addition to the requirements of § 9-231 of...
Section 14-120 - Investments - (a) In this section, “group health care” means a practice...
Section 14-121 - Annual and Interim Statements; Audited Financial Report - (a) (1) On or before March 1 of each year,...
Part IV - Regulatory Authority of Commissioner
Section 14-124 - Hearings and Investigations; Regulations; Delinquency Proceedings - (a) (1) The Commissioner may conduct any investigation or hearing...
Section 14-125 - Inspection and Examination - (a) The Commissioner or an examiner of the Administration may...
Section 14-126 - Filings of Amendments and Rate Changes - (a) (1) A corporation subject to this subtitle may not...
Section 14-127 - Judicial Review - (a) Each decision or finding of the Commissioner about rates...
Part V - Conversion; Acquisitions and Investments
Section 14-130 - "Health Insurer" Defined - In Part V of this subtitle, “health insurer” means an...
Section 14-133 - Investment in or Acquisition of Affiliate or Subsidiary - (a) (1) In this section the following words have the...
Part VI - Prohibited Acts; Penalties
Section 14-136 - Unfair and Discriminatory Trade Practices; Other Prohibited Acts - (a) Nonprofit health service plans are subject to Title 27...
Section 14-137 - Exclusion of Coverage for Violations - A nonprofit health service plan may not issue, renew, or...
Section 14-138 - Disclosure of Medical or Claims Information - (a) Except as provided in subsection (b), (c), or (d)...
Section 14-139 - Prohibited Acts of Officers, Directors, and Employees; Civil Penalty - (a) An officer, director, or employee of a corporation operating...
Section 14-140 - Prohibited Acts; Criminal Penalties - (a) (1) A person may not engage in the business...
Subtitle 2 - Preferred Provider Organizations
Section 14-201 - Definitions - (a) In this subtitle the following words have the meanings...
Section 14-202 - Scope of Subtitle - (a) (1) This subtitle applies to insurers that issue or...
Section 14-203 - Regulations - The Commissioner may adopt regulations to enforce this subtitle.
Section 14-204 - Authority of Insurers - Subject to the approval of the Commissioner, an insurer may:...
Section 14-205 - Benefits for Health Care Services; Payments to and Rates for Providers - (a) If a preferred provider insurance policy offered by an...
Section 14-205.1 - Option to Include Preferred or Nonpreferred Providers - (a) The Commissioner may authorize an insurer or nonprofit health...
Section 14-205.2 - Collection of Money for Services Rendered by On-Call Physician or Hospital-Based Physician - (a) Except as otherwise provided, this section applies to both...
Section 14-205.3 - Assignment of Benefits - (a) This section does not apply to on–call physicians or...
Section 14-206 - Filings With Commissioner - (a) This section applies to an employee benefit plan whose...
Subtitle 4 - Dental Plan Organization Act
Section 14-401 - Definitions - (a) In this subtitle the following words have the meanings...
Section 14-402 - Scope of Subtitle - (a) This subtitle does not apply to: (1) a dentist...
Section 14-403 - Certificate of Authority Required - A person may not establish, operate, or administer a dental...
Section 14-404 - Surplus or Bond - (a) Except as provided in subsection (d) of this section,...
Section 14-405 - Application for Certificate of Authority - (a) An applicant for a certificate of authority shall: (1)...
Section 14-406 - Notice of Modification of Information - Within 10 days after a significant modification of information submitted...
Section 14-407 - Issuance or Disapproval of Certificate of Authority - (a) If the Commissioner is satisfied that the individuals who...
Section 14-408 - Term and Renewal of Certificate of Authority - (a) A certificate of authority expires on the first June...
Section 14-409 - Suspensions and Revocations - (a) The Commissioner may suspend or revoke a certificate of...
Section 14-410 - Evidence of Coverage - (a) Each enrollee shall receive evidence of coverage that indicates...
Section 14-411 - Investigations and Examinations - (a) The Commissioner may investigate the business and examine the...
Section 14-412 - Complaint System - (a) (1) A dental plan organization shall establish and maintain...
Section 14-413 - Annual Report - (a) On or before March 1 of each year, each...
Section 14-414 - Limitation on Use of Income - A dental plan organization may not use more than 50%...
Section 14-415 - Misrepresentation - (a) A dental plan organization or its representative may not...
Section 14-416 - Cease and Desist Orders - (a) The Commissioner may issue an order that directs a...
Section 14-417 - Injunctions - (a) The Commissioner may bring an action in a court...
Section 14-418 - Public Documents; Confidential Records - (a) Except for contracts referred to in § 14-405(b)(5) of...
Subtitle 6 - Discount Medical Plan Organizations and Discount Drug Plan Organizations
Section 14-601 - Definitions - (a) In this subtitle the following words have the meanings...
Section 14-602 - General Consideration - (a) Except as provided in subsection (b) of this section,...
Section 14-603 - Registration Required - (a) (1) An entity shall register with the Commissioner as...
Section 14-604 - Registration -- Expiration and Renewal - (a) A registration expires on the second June 30 following...
Section 14-605 - Registration -- Denial, Refusal to Renew, Suspension, Revocation - (a) Subject to the hearing provisions of Title 2 of...
Section 14-606 - Prohibited Acts - A discount medical plan organization and a discount drug plan...
Section 14-607 - Required Disclosures - (a) The following disclosures shall be made in writing printed...
Section 14-608 - Refunds of Fees, Dues, or Charges on Cancellation of Registration - (a) (1) If membership in a discount medical plan or...
Section 14-609 - Cards - (a) Each discount medical plan organization and each discount drug...
Section 14-610 - Examinations - (a) Whenever the Commissioner considers it advisable, the Commissioner may...
Section 14-611 - Enforcement by Orders of Commissioner - (a) To enforce this subtitle and any regulation adopted under...
Section 14-612 - Regulations - The Commissioner shall adopt regulations to carry out the provisions...