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31.10.10.00.htm 31.10.10.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE โ€• GENERAL Chapter 10 Summary Explanation of Benefits Authority: Insurance Article, ยง2-109 and 15-1007, Annotated Code of Maryland
31.10.10.01.htm 31.10.10.01. 01 Applicability and Scope.. This chapter applies to all health insurers, including nonprofit health service plans, authorized to do business in Maryland, which provide benefits for inpatient hospitalization or outpatient surgical care on an expense-incurred basis in group or individual contracts, both for insured business and business for which the insurer is an administrator.
31.10.10.02.htm 31.10.10.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Claimant" means an insured individual resident in Maryland making a claim against the insurer for benefits, who is a:a) Policyholder covered by an individual policy; or. b) Certificate holder covered under a group policy or under an administration contract.. 2) "Service" means any service for which a charge is made which is covered under the policy or contr
31.10.10.03.htm 31.10.10.03. 03 Summary Form.. A. An insurer which provides benefits for inpatient hospitalization or outpatient surgical care on an expense-incurred basis shall provide claimants annually a consolidated summary explanation regarding benefits claimed for those services during each calendar year.B. The summary shall identify the provider by name and shall state the:. 1) Date of the service;. 3) Amount which was paid or is payable by the insurer on claims processed during the year; and.
31.10.10.04.htm 31.10.10.04. 04 Group Coverage.. Instead of the procedure outlined in Regulation .03 of this chapter, an insurer may make the annual summary to claimants who are covered under group policies, or who are covered under employer-employee groups administered by the insurer, within 36 days after the annual anniversary of the group policy, or of the administration contract, for the 12-month period ending with that anniversary.
31.10.10.05.htm 31.10.10.05. 05 Group Coverage โ€• Election of Alternate Procedure.. A. An insurer desiring to use the alternate procedure specified in Regulation .04 of this chapter may elect the procedure for:1) All groups; or. 2) Groups in excess of a certain size.. B. An insurer shall notify the Insurance Commissioner of its election under this regulation and Regulation .04 of this chapter within 90 days of the effective date of this chapter.C. An insurer that follows the procedures set fort
31.10.10.9999.htm 31.10.10.9999. Administrative History Effective date: December 1, 1993 (20:20 Md. R. 1570) โ€•. Chapter recodified from COMAR 09.30.95 to COMAR 31.10.10 effective September 7, 1998 (25:18 Md. R. 1439)
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