(a) In this section, “emergency medical condition” means a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson, who possesses an average knowledge of health and medicine, to result in:
(1) placing the patient’s health in serious jeopardy;
(2) serious impairment to bodily functions; or
(3) serious dysfunction of any bodily organ or part.
(b) This section applies to:
(1) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups under health insurance policies that are issued or delivered in the State; and
(2) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
(c) (1) An entity subject to this section may not establish or promote an emergency medical response and transportation system that encourages or directs access by an insured or enrollee in competition with or in substitution of the Maryland Emergency Medical Services System (911) or other State, county, or local government emergency medical services system.
(2) Notwithstanding paragraph (1) of this subsection, an entity subject to this section may use transportation outside the 911 or other government emergency medical services system for services that are not in response to an emergency medical condition.
(d) An entity subject to this section may not require an insured or enrollee to obtain prior authorization before accessing the 911 system or other State, county, or local government emergency medical services system for an emergency medical condition.
(e) An entity subject to this section may not use false or misleading language in its enrollment sales materials or in any other materials provided to insureds or enrollees to discourage or prohibit insureds or enrollees from accessing the 911 system for an emergency medical condition.
Structure Maryland Statutes
Subtitle 1 - General Provisions
Section 15-101 - Scope of Title
Section 15-102 - Third-Party Ownership of Policies
Section 15-103 - Simplified Language Required
Section 15-104 - Nonduplication and Coordination Provisions in Policies
Section 15-105 - Coverage Information About Breast Implants
Section 15-106 - Home Medical Equipment
Section 15-107 - Notice to Pharmacies of Change in Pharmaceutical Benefits
Section 15-108 - Record Keeping Procedures
Section 15-109 - Minimum Loss Ratio for Specified Disease Policies
Section 15-110 - Prohibited Referrals
Section 15-111 - Assessment of Fees on Payors
Section 15-112 - Provider Panels
Section 15-112.1 - Carriers and Credentialing Intermediaries; Uniform Credentialing Form
Section 15-112.2 - Provider Contract
Section 15-112.3 - Multi-Carrier Common Online Provider Directory Information System
Section 15-113 - Compensation of Health Care Practitioners or Set of Health Care Practitioners
Section 15-115 - Provider Participation in Managed Care Organizations
Section 15-116 - Communication of Information by Health Care Providers
Section 15-117 - Indemnification of Insurers and Nonprofit Health Service Plans
Section 15-118 - Coinsurance Payments for Health Care Services
Section 15-119 - Uniform Consultation Referral Forms -- in General
Section 15-120 - Uniform Consultation Referral Forms -- Regulations
Section 15-121 - Disclosures Required in Enrollment Sales Materials
Section 15-122 - Notice of Renewal of Health Benefit Plan
Section 15-122.1 - Disbursement of Advance Directive Information Sheet by Carriers
Section 15-123 - Emerging Medical and Surgical Treatments
Section 15-124 - Group Health Insurers -- Enrollment of Minors
Section 15-125 - Restrictions on Assigning, Transferring, or Subcontracting Contracts
Section 15-126 - Access to 911 Emergency System
Section 15-129 - Stop-Loss Insurance Policies
Section 15-130 - Health Insurance Benefit Card, Prescription Benefit Card, Etc
Section 15-130.1 - Health Insurance Benefit Cards, Prescription Benefit Cards, and Other Technology
Section 15-131 - Electronic Reimbursement
Section 15-132 - Incentives to Health Care Providers
Section 15-133 - Annual Report
Section 15-134 - Effect of Federal Patient Protection and Affordable Care Act on Maryland Plans
Section 15-135 - Covered Benefits for Annual Preventive Care
Section 15-135.1 - Dental Preventive Care Coverage
Section 15-136 - Bonus Payments to Primary Care Providers
Section 15-138 - Direct Reimbursement of Ambulance Service Provider
Section 15-139 - Coverage for Services Delivered Through Telehealth
Section 15-141 - Communications Between Carriers and Enrollees -- Confidentiality
Section 15-142 - Step Therapy or Fail-First Protocol
Section 15-143 - Compensation Agreements Arrangements Under Federally Approved Programs and Models
Section 15-145 - Definitions -- When Health Savings Account Established