Maryland Statutes
Insurance
Title 15 - Health Insurance

Section 15-113 - Compensation of Health Care Practitioners or Set of Health Care Practitioners - (a) (1) In this section the following words have the...

Section 15-114 - Dental Plans - (a) (1) In this section the following words have the...

Section 15-115 - Provider Participation in Managed Care Organizations - (a) (1) In this section, “carrier” means: (i) an insurer;...

Section 15-116 - Communication of Information by Health Care Providers - (a) (1) In this section the following words have the...

Section 15-117 - Indemnification of Insurers and Nonprofit Health Service Plans - (a) This section applies to insurers and nonprofit health service...

Section 15-118 - Coinsurance Payments for Health Care Services - (a) (1) In this section the following words have the...

Section 15-119 - Uniform Consultation Referral Forms -- in General - (a) This section applies to insurers and nonprofit health service...

Section 15-120 - Uniform Consultation Referral Forms -- Regulations - (a) Subject to subsection (b) of this section, the Commissioner...

Section 15-121 - Disclosures Required in Enrollment Sales Materials - (a) (1) In this section the following words have the...

Section 15-122 - Notice of Renewal of Health Benefit Plan - (a) In this section, “carrier” means: (1) an insurer; (2)...

Section 15-122.1 - Disbursement of Advance Directive Information Sheet by Carriers - (a) (1) In this section the following words have the...

Section 15-123 - Emerging Medical and Surgical Treatments - (a) (1) In this section the following words have the...

Section 15-124 - Group Health Insurers -- Enrollment of Minors - (a) In this section, “group health insurance” has the meaning...

Section 15-125 - Restrictions on Assigning, Transferring, or Subcontracting Contracts - (a) (1) In this section the following words have the...

Section 15-126 - Access to 911 Emergency System - (a) In this section, “emergency medical condition” means a medical...

Section 15-127 - Distribution of Information by Carrier Owning or Contracting With Managed Behavioral Health Care Organizations - (a) (1) In this section the following words have the...

Section 15-129 - Stop-Loss Insurance Policies - (a) (1) In this section the following words have the...

Section 15-130 - Health Insurance Benefit Card, Prescription Benefit Card, Etc - (a) (1) This section applies to: (i) insurers and nonprofit...

Section 15-130.1 - Health Insurance Benefit Cards, Prescription Benefit Cards, and Other Technology - (a) This section applies to: (1) each health insurer; (2)...

Section 15-131 - Electronic Reimbursement - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-132 - Incentives to Health Care Providers - (a) In this section, “carrier” has the meaning stated in...

Section 15-133 - Annual Report - On or before December 1 of each year, the Commissioner...

Section 15-134 - Effect of Federal Patient Protection and Affordable Care Act on Maryland Plans - (a) In this section, “grandfathered health plan” has the meaning...

Section 15-135 - Covered Benefits for Annual Preventive Care - (a) (1) In this section, “annual preventive care” means an...

Section 15-135.1 - Dental Preventive Care Coverage - (a) (1) In this section the following words have the...

Section 15-136 - Bonus Payments to Primary Care Providers - (a) (1) In this section the following words have the...

Section 15-138 - Direct Reimbursement of Ambulance Service Provider - (a) (1) In this section the following words have the...

Section 15-139 - Coverage for Services Delivered Through Telehealth - (a) (1) In this section, “telehealth” means, as it relates...

Section 15-140 - Provisions for Marylanders Transitioning Between Carriers and Between Carriers and State Programs - (a) (1) In this section the following words have the...

Section 15-141 - Communications Between Carriers and Enrollees -- Confidentiality - (a) (1) In this section the following words have the...

Section 15-142 - Step Therapy or Fail-First Protocol - (a) (1) In this section the following words have the...

Section 15-143 - Compensation Agreements Arrangements Under Federally Approved Programs and Models - (a) In this section, “participation agreement” means a contract that:...

Section 15-144 - Certain Carriers to Issue Report on Certain Health Benefit Plans -- Information Included -- Comparative Analysis of Nonquantitative Treatment Limitations and Data -- Form - // EFFECTIVE UNTIL SEPTEMBER 30, 2026 PER CHAPTERS 211 AND...

Section 15-145 - Definitions -- When Health Savings Account Established - (a) (1) In this section the following words having the...

Subtitle 1A - Consumer Protections

Section 15-1A-01 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1A-02 - Enforcement of Provisions by Commissioner - (a) The Commissioner may enforce: (1) the provisions of this...

Section 15-1A-03 - Adoption of Regulations -- Application to Health Benefit Plan -- Grandfathered Plans - (a) For purposes of this subtitle, to the extent necessary,...

Section 15-1A-04 - Criteria for Health Benefit Plans -- Consistent With Federal Law - For purposes of this subtitle, to the extent necessary, the...

Section 15-1A-05 - Application to Grandfathered Plans -- Prohibition on Certain Exclusions or Denials - (a) This section applies to all grandfathered plans except grandfathered...

Section 15-1A-06 - Certain Factors Prohibited in Consideration -- Extra Premiums Prohibited - (a) A carrier may not establish rules for eligibility, including...

Section 15-1A-07 - Premium Rates Review -- Basis -- Ratio of Premium Rate Variation - (a) (1) This section may not be construed to limit...

Section 15-1A-08 - Coverage Available for Dependent Child Until Age of 26 Years -- Relationship to Insured - (a) A carrier that offers a health benefit plan, including...

Section 15-1A-09 - Acceptance of All Employers and Individuals -- Exceptions - (a) Except as provided in subsections (b) through (d) of...

Section 15-1A-10 - Coverages Required and Additional Charges Prohibited -- Out-of-Network Charges -- Services Recommended or Not by Task Force - (a) Except as provided in subsections (b) and (c) of...

Section 15-1A-11 - Lifetime or Annual Limits on Benefits - (a) Except as provided in subsections (b) and (c) of...

Section 15-1A-12 - Limit on Waiting Period for Otherwise Eligible Individual - A carrier offering a group plan, including a grandfathered plan,...

Section 15-1A-13 - Identification of Participating Primary Care Provider -- Children -- Obstetrical or Gynecological Care - (a) If a carrier requires or provides for the designation...

Section 15-1A-14 - Emergency Services -- Coverages - (a) (1) In this section the following words have the...

Section 15-1A-15 - Summary of Benefits and Coverage Explanation -- Regulations by Commissioner -- Uniform Definitions -- Periodic Review - (a) This section applies to all grandfathered plans and to...

Section 15-1A-16 - Acceptable Medical Loss Ratio -- Calculation - (a) (1) For purposes of this section, “medical loss ratio”:...

Section 15-1A-17 - Required Information Provided by Carrier -- Disclosures -- Hardship Exemptions -- Catastrophic Plans - (a) (1) This section may not be construed to require...

Section 15-1A-18 - Catastrophic Plans -- Regulations Governing - (a) A carrier may offer a catastrophic plan in the...

Section 15-1A-19 - Annual Limitations on Cost Sharing for Essential Health Benefits Covered -- Regulations - (a) (1) In this section, “cost–sharing” means any expenditure required...

Section 15-1A-20 - Prescription Drug Essential Health Benefits for Individual and Small Group Plans - (a) (1) This section applies only to individual plans and...

Section 15-1A-21 - Rescission of Coverage Under Health Benefit Plans -- Exceptions - (a) This section applies to all grandfathered plans and to...

Section 15-1A-22 - Carriers May Refuse or Deny Coverage for Non-Discriminatory Reasons -- Discrimination Based on Sexual Orientation or Gender Identity Prohibited - (a) (1) In this section the following words have the...

Subtitle 2 - Individual Health Insurance Policy Forms and Provisions

Section 15-201 - Form of Policy - (a) A policy of health insurance may not be delivered...

Section 15-202 - Language and Order of Policy Provisions - (a) Except as otherwise provided in this section, each policy...

Section 15-203 - Right to Refuse Renewal - Other than a policy of accident only insurance, each policy...

Section 15-204 - Age Limit; Misstatement of Age - (a) If a policy of health insurance establishes, as an...

Section 15-205 - Policies of Foreign or Alien Insurers; Policies of Domestic Insurers - (a) A policy of a foreign insurer or alien insurer...

Section 15-206 - Policies and Provisions at Variance With Subtitle - (a) A policy provision that is not subject to this...

Section 15-207 - Entire Contract; Changes - Each policy of health insurance shall contain the following provision:...

Section 15-208 - Time Limit on Specified Defenses - (a) Except as provided in subsection (c) of this section,...

Section 15-209 - Grace Period - (a) (1) Subject to subsection (b) of this section, each...

Section 15-210 - Reinstatement - (a) Each policy of health insurance shall contain the following...

Section 15-211 - Notice of Claim - (a) Each policy of health insurance shall contain the following...

Section 15-212 - Claim Forms - Each policy of health insurance shall contain the following provision:...

Section 15-213 - Proofs of Loss - Except as provided in § 12–102(c) of this article, each...

Section 15-214 - Time of Payment of Claims - (a) Each policy of health insurance shall contain the following...

Section 15-215 - Payment of Claims - (a) Each policy of health insurance shall contain the following...

Section 15-216 - Physical Examinations and Autopsy - Each policy of health insurance shall contain the following provision:...

Section 15-217 - Time for Bringing Legal Actions - Each policy of health insurance shall contain the following provision:...

Section 15-218 - Change of Beneficiary - (a) Subject to subsection (b) of this section, each policy...

Section 15-219 - Change of Occupation - A policy of health insurance may contain the following provision:...

Section 15-220 - Misstatement of Age - A policy of health insurance may contain the following provision:...

Section 15-221 - Other Insurance With Insurer - (a) A policy of health insurance may contain the following...

Section 15-222 - Insurance With Other Insurers -- Expense Incurred Benefits - (a) A policy of health insurance may contain the following...

Section 15-223 - Insurance With Other Insurers -- Other Benefits - (a) A policy of health insurance may contain the following...

Section 15-224 - Relation of Earnings to Insurance - (a) A policy of health insurance may contain the following...

Section 15-225 - Unpaid Premiums - A policy of health insurance may contain the following provision:...

Section 15-226 - Conformity With Statutes of Residence - A policy of health insurance may contain the following provision:...

Subtitle 3 - Group and Blanket Health Insurance Policy Forms and Provisions

Section 15-301 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-302 - Group Health Insurance -- in General - (a) Group health insurance is health insurance issued to persons...

Section 15-304 - Group Health Insurance -- Direct Payment of Hospital or Medical Services - (a) Except as provided in §§ 14–205.2 and 14–205.3 of...

Section 15-305 - Blanket Health Insurance -- in General - (a) (1) Blanket health insurance is health insurance issued to...

Section 15-306 - Blanket Health Insurance -- Authority to Issue; Filing Policy Form Required - (a) An insurer that is authorized to issue policies of...

Section 15-308 - Blanket Health Insurance -- Individual Applications and Certificates - (a) An individual who is covered under a policy or...

Section 15-309 - Blanket Health Insurance -- Payment of Benefits - (a) Except as provided in subsections (b) through (d) of...

Section 15-310 - Solicitation of Coverage Under Policy Issued in Other Jurisdiction - A person may not solicit coverage in the State under...

Subtitle 4 - Eligibility for Coverage; Continuation and Conversion of Policies

Section 15-401 - Coverage for Newly Born or Newly Adopted Children or Grandchildren or Minors Under Guardianship - (a) In this section, “date of adoption” means the earlier...

Section 15-402 - Coverage for Unmarried Dependent Incapacitated Children, Grandchildren, and Individuals Under Guardianship - (a) This section applies to: (1) each individual or group...

Section 15-403 - Coverage for Grandchildren - (a) This section applies to: (1) each individual health insurance...

Section 15-403.1 - Coverage for Individuals Under Guardianship - (a) This section applies to: (1) each individual health insurance...

Section 15-403.2 - Coverage for Child Dependent of Domestic Partner - (a) In this section, “child dependent of the domestic partner”...

Section 15-404 - Addition of Children After Death of Spouse - (a) This section applies to: (1) each group or blanket...

Section 15-405 - Enrollment of Child Under Coverage of Insuring Parent - (a) (1) In this section the following words have the...

Section 15-406 - Medical Assistance - (a) In this section, “health insurance coverage” means health care...

Section 15-407 - Continuation Coverage for Surviving Spouses and Dependent Children - (a) (1) In this section the following words have the...

Section 15-408 - Continuation Coverage for Divorced Spouses and Dependent Children - (a) (1) In this section the following words have the...

Section 15-409 - Continuation Coverage for Terminated Employees - (a) (1) In this section the following words have the...

Section 15-409.1 - Continuation Coverage for Involuntarily Terminated Employees -- Small Employers - (a) (1) In this section the following words have the...

Section 15-411 - Open Enrollment of Involuntarily Terminated Spouse Losing Coverage - (a) Each group health insurance contract or policy that is...

Section 15-413 - Conversion From Group to Individual Policy -- Group Health Insurance Policies With Disability Benefits - (a) (1) Except as provided in paragraph (2) of this...

Section 15-416 - Notice to Parents of Impending Loss of Child's Coverage - (a) This section applies to insurers, nonprofit health service plans,...

Section 15-417 - Coverage for Part-Time Students With Disabilities - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-418 - Child Dependent Coverage - (a) (1) In this section the following words have the...

Subtitle 5 - Prohibited Denials, Exclusions, and Reductions of Coverage

Section 15-501 - Increased Social Security Payments - An individual, group, or blanket health insurance contract may not...

Section 15-502 - Eligibility for State Medical Assistance - (a) This section applies to each individual or group policy...

Section 15-503 - Exposure to Diethylstilbestrol - An insurer or nonprofit health service plan may not deny,...

Section 15-505 - Exclusion of Payments for Leaving Home Confinement - (a) This section applies to each individual, group, or blanket...

Section 15-506 - Effect of Marital Status on Maternity Benefits - (a) Each insurer and nonprofit health service plan that provides...

Section 15-508.1 - Exclusionary Provisions - (a) (1) In this section the following words have the...

Section 15-509 - Incentive for Health-Contingent Wellness Program - (a) (1) In this section the following words have the...

Section 15-510 - Behavioral Health Care Services Provided at Public School or School-Based Health Center - No individual, group, or blanket insurance policy or contract issued...

Subtitle 6 - Required Reimbursement of Institutions

Section 15-601 - Benefits for Using Low-Cost Hospitals - (a) This section applies to insurers and nonprofit health service...

Section 15-602 - Treatment in State or Local Government Hospitals or Institutions - (a) This section applies to each individual, group, or blanket...

Section 15-603 - Reimbursement of Maryland Department of Health - (a) If the Maryland Department of Health notifies an insurer...

Section 15-604 - Rates for Payments to Hospitals; Compliance With All-Payor Model Contract - Each authorized insurer, nonprofit health service plan, and fraternal benefit...

Section 15-605 - Rates for Health Benefit Plans - (a) (1) On or before March 1 of each year,...

Subtitle 7 - Required Reimbursement for Services of Health Care Providers

Section 15-701 - Licensed Health Care Providers - (a) (1) This subsection applies to each individual or group...

Section 15-702 - Dentists, Physicians, and Podiatrists Under Self-Funded Group Insurance Plans - (a) This section applies to each self-funded group insurance plan...

Section 15-703 - Certified Nurse Practitioners - (a) In this section, “certified nurse practitioner” means a licensed...

Section 15-704 - Licensed Professional Counselors - (a) This section applies to each individual, group, or blanket...

Section 15-705 - Chiropractors - For the purposes of a policy of health insurance or...

Section 15-706 - Dietitians and Nutritionists - (a) (1) Subject to subsection (c) of this section, a...

Section 15-707 - Licensed Certified Social Workers - (a) This section applies to each individual, group, or blanket...

Section 15-708 - Nurse Anesthetists - (a) In this section, “nurse anesthetist” means a registered nurse...

Section 15-709 - Nurse Midwives - (a) In this section, “nurse midwife” means a licensed registered...

Section 15-710 - Optometrists - (a) This section applies to each individual or group health...

Section 15-711 - Physical Therapists - (a) This section applies to each individual or group health...

Section 15-712 - Physician Assistants - Notwithstanding § 15-701(a) of this subtitle, unless a policy, contract,...

Section 15-713 - Podiatrists - (a) This section applies to individual, group, or blanket health...

Section 15-714 - Psychologists - (a) This section applies to each individual or group health...

Section 15-715 - Community Health Resource - (a) This section applies to each individual or group health...

Section 15-716 - Administration of Self-Administered Medications and Maintenance Injectable Medications by Licensed Pharmacists - (a) This section applies to individual, group, or blanket health...

Subtitle 8 - Required Health Insurance Benefits

Section 15-801 - Benefits for Alzheimer's Disease and Care of Elderly Individuals - (a) This section applies to: (1) insurers that propose to...

Section 15-802 - Benefits for Treatment of Mental Illnesses, Emotional Disorders, and Drug and Alcohol Misuse - (a) (1) In this section the following words have the...

Section 15-803 - Payments for Blood Products - (a) An insurer or nonprofit health service plan that issues...

Section 15-804 - Coverage for Off-Label Use of Drugs - (a) (1) In this section the following words have the...

Section 15-805 - Reimbursement for Pharmaceutical Products - (a) (1) In this section the following words have the...

Section 15-806 - Choice of Pharmacy for Filling Prescriptions - A nonprofit health service plan that provides pharmaceutical services shall...

Section 15-807 - Coverage for Medical Foods and Modified Food Products - (a) (1) In this section the following words have the...

Section 15-808 - Benefits for Home Health Care - (a) In this section, “home health care” means the continued...

Section 15-809 - Benefits for Hospice Care Services - (a) (1) Each insurer that issues or delivers individual health...

Section 15-810 - Benefits for in Vitro Fertilization - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-810.1 - Coverage for Standard Fertility Preservation Procedures - (a) (1) In this section the following words have the...

Section 15-811 - Hospitalization Benefits for Childbirth - (a) Each insurer and nonprofit health service plan that issues...

Section 15-812 - Inpatient Hospitalization Coverage for Mothers and Newborn Children - (a) (1) In this section the following words have the...

Section 15-813 - Benefits for Disability Caused by Pregnancy or Childbirth - (a) This section applies to each group or blanket health...

Section 15-814 - Coverage for Breast Cancer Screenings - (a) In this section, “digital tomosynthesis” means a radiologic procedure...

Section 15-815 - Coverage for Reconstructive Breast Surgery - (a) (1) In this section the following words have the...

Section 15-816 - Benefits for Routine Gynecological Care - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-817 - Coverage for Child Wellness Services - (a) In this section, “child wellness services” means preventive activities...

Section 15-818 - Benefits for Treatment of Cleft Lip and Cleft Palate - (a) This section applies to: (1) each individual or group...

Section 15-819 - Coverage for Outpatient Services and Second Opinions - (a) This section applies to: (1) each individual, group, or...

Section 15-820 - Benefits for Orthopedic Braces - (a) In this section, “orthopedic brace” means a rigid or...

Section 15-821 - Diagnostic and Surgical Procedures for Bones of Face, Neck, and Head - (a) This section applies to each policy or contract that...

Section 15-822 - Coverage for Diabetes Equipment, Supplies, and Self-Management Training - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-823 - Coverage for Osteoporosis Prevention and Treatment - (a) (1) In this section the following words have the...

Section 15-824 - Coverage for Maintenance Drugs - (a) (1) In this section the following words have the...

Section 15-825 - Coverage for Detection of Prostate Cancer - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-826 - Coverage for Prescription Drugs - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-826.1 - Coverage for Contraceptive Drugs and Devices - (a) In this section, “authorized prescriber” has the meaning stated...

Section 15-826.2 - Coverage for Male Sterilization - (a) (1) In this subsection, “group” means a group that...

Section 15-826.3 - Coverage for Fertility Awareness-Based Methods - (a) In this section, “fertility awareness–based methods” means methods of...

Section 15-827 - Coverage for Patient Cost for Clinical Trials - (a) (1) In this section the following words have the...

Section 15-828 - Coverage for Charges Related to Dental Care - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-829 - Coverage for Detection of Chlamydia - (a) (1) In this section the following words have the...

Section 15-830 - Referrals to Specialists - (a) (1) In this section the following words have the...

Section 15-831 - Coverage of Prescription Drugs - (a) (1) In this section the following words have the...

Section 15-832 - Coverage for Removal of Testicle - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-832.1 - Inpatient Hospitalization Coverage Following Mastectomy - (a) In this section, “mastectomy” means the surgical removal of...

Section 15-833 - Extension of Benefits - (a) A policy will be considered to provide benefits on...

Section 15-834 - Coverage for Prostheses - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-835 - Required Coverage for Habilitative Services - (a) (1) In this section the following words have the...

Section 15-836 - Hair Prosthesis - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-837 - Colorectal Cancer Screening Coverage - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-838 - Hearing Aid Coverage for a Minor Child - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-839 - Coverage for Treatment of Morbid Obesity - (a) (1) In this section the following words have the...

Section 15-840 - Coverage for Medically Necessary Residential Crisis Services - (a) In this section, “residential crisis services” means intensive mental...

Section 15-841 - Coverage for Smoking Cessation Treatment - (a) (1) In this section the following words have the...

Section 15-842 - Copayment or Coinsurance for Prescription Drugs and Devices Limited - (a) (1) This section applies to: (i) insurers and nonprofit...

Section 15-843 - Coverage for Amino Acid-Based Elemental Formula - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-844 - Benefits for Prosthetic Devices - (a) In this section, “prosthetic device” means an artificial device...

Section 15-845 - Coverage for Refills of Prescription Eye Drops - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-846 - Coverage for Cancer Chemotherapy - (a) In this section, “cancer chemotherapy” means medication that is...

Section 15-847 - Coverage for Specialty Drugs - (a) (1) In this section the following words have the...

Section 15-847.1 - Copayment or Coinsurance Limits for Certain Drugs -- Annual Increase Regulated - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-848 - Coverage for Ostomy Equipment and Supplies - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-849 - Coverage for Abuse-Deterrent Opioid Analgesic Drug Products - (a) (1) In this section the following words have the...

Section 15-850 - Prior Authorizations for Opioid Antagonist - (a) In this section, “opioid antagonist” means: (1) naloxone hydrochloride;...

Section 15-851 - Prior Authorization for Drug Products to Treat Opioid Use Disorder -- Prohibition - (a) (1) This section applies to: (i) insurers and nonprofit...

Section 15-852 - Prorated Daily Copayment or Coinsurance Amount for Partial Supply of Prescription Drug - (a) (1) In this section the following words have the...

Section 15-853 - Coverage for Lymphedema Diagnosis, Evaluation, and Treatment - (a) (1) In this section, “gradient compression garment” means a...

Section 15-854 - Prior Authorization for Prescription Drug - (a) (1) This section applies to: (i) insurers and nonprofit...

Section 15-855 - Coverage for Pediatric Autoimmune Neuropsychiatric Disorders - (a) This section applies to: (1) insurers and nonprofit health...

Section 15-856 - // EFFECTIVE UNTIL DECEMBER 31, 2022 PER CHAPTERS 29 AND...

Subtitle 9 - Medicare Supplement Act

Section 15-901 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-902 - Legislative Intent - This subtitle is not intended to prohibit or apply to...

Section 15-903 - Scope of Subtitle - (a) Notwithstanding any other provision to the contrary, this subtitle...

Section 15-904 - Compliance With Subtitle Required; Medicare Select Program - (a) A carrier may not issue, deliver, or renew a...

Section 15-905 - Restoration of Benefits - A carrier shall restore any benefit that was eliminated from...

Section 15-906 - Policy Provisions - (a) A Medicare supplement policy shall provide the minimum benefits...

Section 15-907 - Mammography Screening - (a) In this section, “low-dose mammography” means an x-ray examination...

Section 15-908 - Approval of Additional Benefits - The Commissioner shall approve Medicare supplement policies that include benefits...

Section 15-909 - Policy Provisions; Policy Replacement; Cancellation, Nonrenewal, or Termination of Policies - (a) This section does not extend the number of days...

Section 15-910 - Return of Policy; Refund - (a) Each Medicare supplement policy or certificate shall have prominently...

Section 15-911 - Minimum Loss Ratio Standards for Policies - (a) In this section, “loss ratio” means the ratio of...

Section 15-912 - Specific Standards for Policy Provisions - (a) The Commissioner shall adopt reasonable regulations to establish specific...

Section 15-913 - Prohibited Policy Provisions - The Commissioner shall adopt reasonable regulations that specify prohibited policy...

Section 15-914 - Other Minimum Standards - The Commissioner shall adopt reasonable regulations to establish minimum standards...

Section 15-915 - Conformity With Federal Law - (a) The Commissioner shall adopt reasonable regulations as necessary to...

Section 15-916 - Medicare Supplement Buyer's Guide - (a) The Commissioner shall prepare in clear, plain English the...

Section 15-917 - Outline of Coverage - (a) In order to provide for full and fair disclosure...

Section 15-918 - Informational Brochure - (a) The Commissioner may prescribe by regulation a standard form...

Section 15-919 - Required Statements to Prospective Buyers - (a) (1) Under any circumstance stated in this section, a...

Section 15-920 - Caption and Notice Requirements - The Commissioner may adopt regulations for captions or notice requirements,...

Section 15-921 - Disclosure of Information About Replacement of Policies - The Commissioner may adopt reasonable regulations to govern the full...

Section 15-922 - Compensation of Insurance Producer and Other Representatives - (a) (1) In this section, “compensation” means any pecuniary or...

Section 15-923 - Review of Policy Advertisements - Each carrier that offers a Medicare supplement policy in the...

Section 15-924 - Solicitations of Sales of Health Insurance Policies to Individuals Eligible for Medicare - (a) Solicitation of the sale of a health insurance policy...

Section 15-925 - Prohibited Solicitations - (a) When soliciting the sale of a health insurance policy,...

Section 15-926 - Information to Health Care Financing Administration - (a) Each carrier that issues Medicare supplement policies shall provide...

Section 15-927 - Penalties - In addition to any other applicable penalties for violations of...

Section 15-928 - Short Title - This subtitle is the Medicare Supplement Act.

Subtitle 10 - Claims and Utilization Review

Section 15-1001 - Requirement for Utilization Review - (a) This section applies to entities that propose to issue...

Section 15-1002 - Claim Forms to Conform to Regulations - To provide a standard system of payment for medical services,...

Section 15-1003 - Adoption of Uniform Claims Forms Required - (a) (1) In this section the following words have the...

Section 15-1004 - Acceptance of Uniform Claims Forms Required - (a) For services rendered by a person entitled to reimbursement...

Section 15-1005 - Prompt Payment of Claims - (a) In this section, “clean claim” means a claim for...

Section 15-1006 - Notice of Reason for Denial of Claim - (a) On written request of the claimant, an insurer that...

Section 15-1007 - Summary Explanation of Benefits - (a) This section applies to insurers and nonprofit health service...

Section 15-1008 - Retroactive Denial of Reimbursement - (a) (1) In this section the following words have the...

Section 15-1009 - "Carrier" Defined; Reimbursement for Preauthorized Care; Payment of Claims - (a) In this section, “carrier” means: (1) an insurer; (2)...

Section 15-1010 - "Disability Benefit" and "Adverse Benefit Determination" Defined; Regulations - (a) (1) In this section the following words have the...

Section 15-1011 - Expense Reimbursement Claims Forms -- Methods for Submission - (a) (1) This section applies to: (i) insurers and nonprofit...

Subtitle 10A - Complaint Process for Adverse Decisions or Grievances

Section 15-10A-01 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-10A-01.1 - Applicability - This subtitle applies to a health benefit plan that: (1)...

Section 15-10A-02 - Internal Grievance Process - (a) Each carrier shall establish an internal grievance process for...

Section 15-10A-03 - Review of Grievance Decision - (a) (1) Within 4 months after the date of receipt...

Section 15-10A-04 - Decisions -- Final Decision; Notice; Hearing; Remedies for Noncompliance - (a) The Commissioner shall: (1) notwithstanding the provisions of §...

Section 15-10A-05 - Independent Review Organizations or Medical Experts - (a) For a complaint filed with the Commissioner under this...

Section 15-10A-06 - Quarterly Reports by Carrier to Commissioner; Annual Summary Report by Commissioner - (a) On a quarterly basis, each carrier shall submit to...

Section 15-10A-07 - Quarterly Report to Commissioner by Health Advocacy Unit - On a quarterly basis, the Health Advocacy Unit shall submit...

Section 15-10A-08 - Annual Summary Report by Health Advocacy Unit - (a) On or before November 1, 1999, and each November...

Section 15-10A-09 - Regulations; Right to Challenge Decision Resulting in Nonpayment - (a) The Commissioner shall adopt regulations to carry out this...

Section 15-10A-10 - Requirements of Notice by Carrier - A carrier shall provide the notices required to be provided...

Subtitle 10B - Private Review Agents

Section 15-10B-01 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-10B-02 - Purpose of Subtitle - The purpose of this subtitle is to: (1) promote the...

Section 15-10B-03 - Certificates -- Required; Issuance; Transferability; Regulations; Uniform Treatment Plan Form - (a) A private review agent may not conduct utilization review...

Section 15-10B-04 - Certificates -- Application; Fees - (a) An applicant for a certificate shall: (1) submit an...

Section 15-10B-05 - Certificates -- Additional Information - (a) In conjunction with the application, the private review agent...

Section 15-10B-06 - Determinations by Private Review Agent - (a) (1) A private review agent shall: (i) make all...

Section 15-10B-07 - Adverse Decisions by Private Review Agent - (a) (1) Except as provided in paragraphs (2) and (3)...

Section 15-10B-08 - Requirements of Internal Grievance Process - (a) If a carrier delegates its internal grievance process to...

Section 15-10B-09 - Requirements of Internal Grievance Process -- Maternity and Newborn Care - (a) In this section, “attending provider” means an obstetrician, pediatrician,...

Section 15-10B-09.1 - Requirements of Grievance Decision - A grievance decision shall be made based on the professional...

Section 15-10B-10 - Certificates -- Expiration; Renewal - (a) A certificate expires on the second anniversary of its...

Section 15-10B-11 - Private Review Agent -- Prohibitions - A private review agent may not: (1) violate any provision...

Section 15-10B-12 - Private Review Agent -- Penalties - (a) (1) A person who violates any provision of §...

Section 15-10B-13 - Right to Hearing and Appeal From Action of Commissioner - Any person aggrieved by an order of the Commissioner under...

Section 15-10B-14 - Waiver of Requirements for Review of Certain Patients - The Commissioner may waive the requirements of this subtitle for...

Section 15-10B-15 - List of Private Review Agents - The Commissioner shall periodically provide a list of private review...

Section 15-10B-16 - Reporting Requirements - The Commissioner may establish reporting requirements to: (1) evaluate the...

Section 15-10B-17 - Patient Referrals by Private Review Agents - (a) (1) Except as provided in paragraph (2) of this...

Section 15-10B-18 - Withdrawal and Submission of Certificate - (a) A private review agent shall advise the Commissioner, in...

Section 15-10B-19 - Examination by Commissioner - (a) Whenever the Commissioner considers it advisable, the Commissioner shall...

Section 15-10B-20 - Examination by Commissioner -- Pharmacy Benefit Manager - (a) In addition to the requirements under § 15-10B-19 of...

Subtitle 10C - Medical Directors

Section 15-10C-01 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-10C-02 - Establishment of Regulations by Commissioner - The Commissioner, in consultation with the Department and the Board,...

Section 15-10C-03 - Requirements for Application of Medical Director - (a) To be certified as a medical director under this...

Section 15-10C-04 - Suspension or Revocation by Commissioner of Certificate of Medical Director - (a) Subject to the hearing procedures in §§ 2-210 through...

Subtitle 10D - Complaint Process for Coverage Decisions

Section 15-10D-01 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-10D-02 - Appeals - (a) (1) Each carrier shall establish an internal appeal process...

Section 15-10D-03 - Obligations of Carrier - (a) It is a violation of this subtitle for a...

Section 15-10D-04 - Regulations - The Commissioner may adopt any necessary regulations to carry out...

Section 15-10D-05 - Requirements of Notice by Carrier - A carrier shall provide the notices required to be provided...

Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans

Section 15-1102 - Franchise Health Insurance Policies - (a) In this section, “employee” includes: (1) an officer, manager,...

Section 15-1103 - Transportation Ticket Health Insurance Policies - (a) In this section, “transportation ticket policy” means a ticket...

Section 15-1104 - Limited Benefit Group Health Insurance Contracts - (a) (1) In this section the following words have the...

Section 15-1106 - Rescission of Health Benefit Plan - (a) (1) In this section the following words have the...

Subtitle 12 - Maryland Health Insurance Reform Act

Section 15-1201 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1202 - Scope of Subtitle - (a) This subtitle applies only to a health benefit plan...

Section 15-1204 - Requirements and Limitations for Carriers - (a) This section applies to a carrier with respect to...

Section 15-1204.1 - Carrier Required to Offer Qualified Health Plans in Small Business Health Options Program in Compliance With Title 31 Along With Other Health Benefit Plans to Small Employers - (a) This section applies to a carrier with respect to...

Section 15-1205 - Premium Rates for Health Benefit Plans - (a) (1) This subsection applies to a carrier with respect...

Section 15-1206 - Miscellaneous Operations Requirements for Carriers - (a) (1) A carrier may not arbitrarily transfer a small...

Section 15-1207 - Comprehensive Standard Health Benefit Plan and Modified Plans - (a) In accordance with Title 19, Subtitle 1 of the...

Section 15-1208 - Applicability of 15-508 - The provisions of § 15–508 of this title apply to...

Section 15-1208.1 - Special Enrollment Periods in Small Employer Health Benefit Plans - (a) A carrier shall provide the special enrollment periods described...

Section 15-1208.2 - Annual Open Enrollment Periods for Small Employers - (a) (1) In this section the following words have the...

Section 15-1209 - Issuance of Health Benefit Plans - (a) This section does not apply to any insurance enumerated...

Section 15-1210 - Offering of Coverage by Carriers - (a) A carrier that offers coverage to a small employer...

Section 15-1211 - Approval of Proposed Health Benefit Plans - (a) To sell health benefit plans to small employers in...

Section 15-1212 - Renewal of Health Benefit Plans - (a) (1) In this section the following words have the...

Section 15-1213 - Benefits Additional to Standard Plan - (a) This section does not apply to any insurance enumerated...

Section 15-1214 - Reimbursement of Hospitals - Notwithstanding any other provision of this subtitle, health benefit plans...

Section 15-1215 - Election to Become Risk-Assuming Carrier or Reinsuring Carrier - (a) (1) Each carrier shall elect to become either a...

Section 15-1216 - Small Employer Health Reinsurance Pool - (a) The Commissioner shall establish the Maryland Small Employer Health...

Section 15-1217 - Requirements for Plan of Operation; Powers of Board - (a) At a minimum, the plan of operation shall: (1)...

Section 15-1218 - Reinsurance - (a) A reinsuring carrier may reinsure with the Pool as...

Section 15-1219 - Premiums for Reinsurance - (a) (1) (i) As part of the plan of operation,...

Section 15-1220 - Management of Pool Money - (a) The Pool shall manage and invest all money collected...

Section 15-1221 - Assessments to Recoup Losses by Pool - (a) On or before the last day of February of...

Section 15-1222 - Reports; Audits - (a) (1) The Board shall report to the Commissioner on...

Section 15-1223 - Immunity of Pool and Reinsuring Carriers - Participation in the Pool as reinsuring carriers, establishment of rates,...

Section 15-1224 - Dissolution of Pool - The Commissioner may order the dissolution of the Pool if...

Section 15-1225 - Short Title - This subtitle is the Maryland Health Insurance Reform Act.

Subtitle 13 - Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms

Section 15-1301 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1302 - Scope of Subtitle - (a) This subtitle applies to all carriers that offer health...

Section 15-1303 - Requirements for Carriers - (a) In addition to any other requirements under this article,...

Section 15-1307 - Actuarial Value of Benefits - (a) The actuarial value of benefits provided under individual health...

Section 15-1308 - Individual Health Benefit Plans - (a) In this section, “affiliate” means a person that directly...

Section 15-1309 - Renewal of Individual Health Benefit Plans - (a) (1) In this section the following words have the...

Section 15-1313 - List of Carriers That Provide Individual Health Benefit Plans - The Administration shall provide on its Web site and in...

Section 15-1314 - Increasing Individual Premiums on Health Benefit Plans - (a) Except as provided in subsection (c) of this section,...

Section 15-1315 - Plans Issued Through Individual Exchange - (a) (1) In this section the following words have the...

Section 15-1316 - Annual Open Enrollment Period - (a) (1) In this section the following words have the...

Section 15-1317 - Initial Open Enrollment Period - (a) A carrier that sells health benefit plans to individuals...

Section 15-1318 - Student Health Plans - (a) (1) In this section the following words have the...

Subtitle 14 - Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms

Section 15-1401 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1402 - Scope of Subtitle - (a) Subject to subsection (b) of this section, this subtitle...

Section 15-1406 - Eligibility of Individual to Enroll Under Group Plan - (a) A carrier may not establish rules for eligibility of...

Section 15-1406.1 - Enrollment of Dependents - (a) In this section, “eligible employee” means: (1) a participant...

Section 15-1407 - Premiums Based on Health Status-Related Factors - A carrier may not require an individual member of a...

Section 15-1408 - Renewal of Group Health Benefit Plan - A carrier shall renew group health benefit plans at the...

Section 15-1409 - Nonrenewal of Plans - (a) In this section, “product” means a discrete package of...

Section 15-1410 - Applicability of Affordable Care Act Provisions - (a) In this section, “plan year” has the meaning stated...

Section 15-1411 - Disclosure of Aggregate Incurred Claims - (a) (1) In this section the following words have the...

Subtitle 15 - Mandated Health Insurance Services Evaluation

Section 15-1501 - Mandated Health Insurance Services - (a) (1) In this subtitle the following words have the...

Section 15-1502 - Evaluation of Mandated Health Insurance Services - (a) (1) The Commission shall conduct an evaluation of existing...

Subtitle 16 - Pharmacy Benefits Managers

Part I - Definitions

Section 15-1601 - Definitions - (a) In this subtitle the following words have the meanings...

Part II - Registration and Regulation of Pharmacy Benefits Managers

Section 15-1604 - Registration - (a) A pharmacy benefits manager shall register with the Commissioner...

Section 15-1605 - Expiration; Renewal - (a) A pharmacy benefits manager registration expires on the second...

Section 15-1606 - Agreements With Unregistered Pharmacy Benefits Managers Prohibited - A carrier may not enter into an agreement with a...

Section 15-1607 - Denials, Suspensions, Revocations, and Refusals to Renew - (a) Subject to the applicable hearing provisions of Title 2...

Section 15-1608 - Books and Records - A pharmacy benefits manager shall maintain adequate books and records...

Section 15-1609 - Examinations - (a) Whenever the Commissioner considers it advisable, the Commissioner may...

Section 15-1610 - Delivery Through Nonresident Pharmacies - A pharmacy benefits manager may not ship, mail, or deliver...

Section 15-1611 - Information on and Sales of Prescription Drugs - (a) This section applies only to a pharmacy benefits manager...

Section 15-1611.1 - Choice of Pharmacy by Beneficiary to Fill Prescription - (a) This section applies only to a pharmacy benefits manager...

Section 15-1612 - Reimbursement for Pharmaceutical Product or Pharmacist Service - (a) This section applies only to a pharmacy benefits manager...

Part III - Pharmacy and Therapeutics Committees

Section 15-1613 - In General - A pharmacy and therapeutics committee established by a pharmacy benefits...

Section 15-1614 - Composition; Conflict of Interest Statement - (a) (1) A pharmacy and therapeutics committee shall: (i) include...

Section 15-1615 - Mandatory Participation on Committee Prohibited - A pharmacy benefits manager may not require a pharmacist to...

Section 15-1616 - Disclosure About Composition - On request of a purchaser for which the pharmacy and...

Section 15-1617 - Required Policies, Procedures, and Processes - A pharmacy benefits manager shall ensure that its pharmacy and...

Section 15-1618 - Accreditation - The Commissioner may consider a pharmacy and therapeutics committee of...

Section 15-1619 - Regulations - The Commissioner may adopt regulations to implement this part.

Part IV - Disclosures to Purchasers

Section 15-1622 - Scope of Part - (a) Except as provided for in subsection (b) of this...

Section 15-1623 - Requirements Before Entering Into Contract - (a) Before entering into a contract with a purchaser, a...

Section 15-1624 - Rebate Sharing Contract - (a) If a purchaser has a rebate sharing contract, a...

Section 15-1625 - Effect of Part - This part does not diminish the authority of the Office...

Part V - Contracts With Pharmacies and Pharmacists; Audits

Section 15-1628 - Required Disclosures by Pharmacy Benefits Manager; Filing Requirements for Contract or Amendment to Contract - (a) For disputes regarding cost pricing and reimbursement under a...

Section 15-1628.1 - Maximum Allowable Cost Pricing Between Pharmacy Benefits Manager and Contracted Pharmacy - (a) (1) In this section the following words have the...

Section 15-1628.3 - Fee or Performance-Based Reimbursement Related to Claim Adjudication - (a) A pharmacy benefits manager or a carrier may not...

Section 15-1629 - Audits by Pharmacy Benefits Manager - (a) This section applies only to a pharmacy benefits manager...

Section 15-1630 - Internal Review Process - (a) This section applies only to a pharmacy benefits manager...

Section 15-1631 - Retroactive Denial or Modification of Reimbursement for Approved Claim - Except for an overpayment as defined in § 15–1629(h) of...

Part VI - Therapeutic Interchanges

Section 15-1633 - When Request Allowed - A pharmacy benefits manager or its agent may not request...

Section 15-1634 - Authorization; Disclosures; Money-Saving Claims; Payment for Interchange - (a) Before making a therapeutic interchange, a pharmacy benefits manager...

Section 15-1635 - Requirements When Interchange Occurs - If a therapeutic interchange occurs, the pharmacy benefits manager or...

Section 15-1636 - Cancellation and Reversal - (a) A pharmacy benefits manager or its agent shall cancel...

Section 15-1637 - Maintenance of Toll-Free Telephone Number - (a) A pharmacy benefits manager shall maintain a toll–free telephone...

Section 15-1638 - Privacy Standards - All disclosures made under this part shall comply with the...

Section 15-1639 - Policies and Procedures - A pharmacy benefits manager shall establish appropriate policies and procedures...

Part VII - Penalties

Section 15-1642 - Violations; Enforcement - (a) It is a violation of this subtitle for a...

Subtitle 17 - Regulation of Physician Rating Systems

Section 15-1701 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1702 - General Consideration - (a) A carrier may not use a physician rating system...

Section 15-1703 - Appeals Process - (a) A carrier that uses a physician rating system shall:...

Section 15-1704 - Notification of Results of Review; Finding of Noncompliance; Reports - (a) A carrier shall notify the Commissioner of the results...

Subtitle 19 - Clinically Integrated Organizations

Section 15-1901 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-1902 - Contract Between Carrier and a Clinically Integrated Organization - (a) Notwithstanding any other provision of this article or the...

Section 15-1903 - Sharing Medical Information - Notwithstanding any other provision of this article or the Health...

Subtitle 20 - Pharmacy Services Administrative Organizations

Section 15-2001 - Definitions - (a) In this subtitle the following words have the meanings...

Section 15-2002 - Registration as Pharmacy Services Administrative Organization -- Requirements - (a) On or after July 1, 2021, a pharmacy services...

Section 15-2003 - Expiration or Renewal of Registration - (a) A pharmacy services administrative organization registration expires on the...

Section 15-2004 - Registration Prerequisite to Agreements or Contracts - A pharmacy services administrative organization that has not registered with...

Section 15-2005 - Basis of Denial of Registration or Suspension or Revocation - Subject to the applicable hearing provisions of Title 2 of...

Section 15-2006 - Recordkeeping Requirements - A pharmacy services administrative organization shall maintain adequate books and...

Section 15-2007 - Review by Commissioner -- Expense - (a) Whenever the Commissioner considers it advisable, the Commissioner may...

Section 15-2008 - Adoption of Regulations - The Commissioner may adopt regulations to implement this subtitle.

Section 15-2009 - Review Authority Not Diminished - This subtitle may not be construed to diminish the authority...

Section 15-2010 - Filing of Contract or Amendment to Contract - (a) A pharmacy services administrative contract or an amendment to...

Section 15-2011 - Provision of Certain Documents by Pharmacy Services Administrative Organization -- Confidential - (a) A pharmacy services administrative contract shall include a provision...

Section 15-2012 - Disclosure of Ownership or Control to Commissioner -- Notification of Changes - (a) Each pharmacy services administrative organization shall disclose to the...

Section 15-2013 - Disclosure of Ownership or Control to Independent Pharmacy -- Notification of Changes - (a) Before entering into a pharmacy services administrative contract, a...

Section 15-2014 - Disclosure of Ownership or Control to Purchaser or Pharmacy Benefits Manager -- Notification of Changes - (a) Before entering into a contract with a purchaser or...

Section 15-2015 - Timely Submission of Remittances - A pharmacy services administrative contract shall: (1) require all remittances...

Section 15-2016 - Certain Contractual Requirements Prohibited -- Certain Disclosures to Commissioner - (a) A pharmacy services administrative organization that owns or is...

Section 15-2017 - Confidentiality of Disclosures - (a) All disclosures made under this subtitle shall comply with...

Section 15-2018 - Implementation Policies and Procedures - A pharmacy services administrative organization shall establish appropriate policies and...

Section 15-2019 - Pharmacy Services Administrative Organization Prohibited From Certain Actions -- Violations and Penalties -- Service of Notices -- Regulatory Authority - (a) A pharmacy services administrative organization may not: (1) misrepresent...

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Maryland Statutes Insurance Title 15 - Health Insurance

Maryland Statutes
Insurance
Title 15 - Health Insurance