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31.10.17.00.htm 31.10.17.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 17 Health Care Consumer Information and Education Act Authority: Insurance Article, §2-109 and 15-121; Health-General Article, §19-706; Annotated Code of Maryland
31.10.17.01.htm 31.10.17.01. 01 Scope.. This chapter applies to all carriers that provide health care services to enrollees or otherwise make health care services available to enrollees through contracts with providers.
31.10.17.02.htm 31.10.17.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Carrier" means:. a) An insurer;. b) A nonprofit health service plan;. c) A health maintenance organization;. d) A dental plan organization;. e) Any person or entity acting as a third-party administrator; or. f) Except for a managed care organization as defined in Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland, any other person tha
31.10.17.03.htm 31.10.17.03. 03 Information to be Disclosed.. A. Each carrier that provides health care services to enrollees, or otherwise makes health care services available to enrollees through contracts with providers, shall disclose in its enrollment sales material the:1) Methodology or methodologies that the carrier uses to compensate the physicians for health care services rendered to enrollees; and2) Distribution of each $100 it receives in premium dollars from enrollees for the preceding calenda
31.10.17.04.htm 31.10.17.04. 04 Disclosure of Compensation Methodologies.. A. Each carrier shall include the following in its enrollment sales materials:. 1) The following disclosure statement typeset in bold italic type:. Our compensation to physicians who offer health care services to our insured members or enrollees may be based on a variety of payment mechanisms such as fee-for-service payments, salary, or capitation. Bonuses may be used with these various types of payment methods.If you desire additional
31.10.17.05.htm 31.10.17.05. 05 Disclosure of Distribution of Premium Dollars.. A. The disclosure required under this regulation shall:. 1) Be in the form of a pie chart or bar graph; and. 2) Identify, in layman's terms, the proportion of every $100 in premium dollars that the carrier uses to pay:a) Providers for the provision of health care services to enrollees, including what proportion is for direct medical care expenses, andb) For plan administration.. B. The computation used in the pie chart or bar gr
31.10.17.06.htm 31.10.17.06. 06 Manner of Disclosure.. The disclosures required by this chapter may be on a separate form, which shall be provided to employers at the time of plan selection and to enrollees at the time of enrollment.
31.10.17.07.htm 31.10.17.07. 07 Other Permitted Disclosures.. A. A carrier may disclose on the pie chart or bar graph that the administrative expenses do not include taxes.B. A carrier may disclose on the pie chart or bar graph whether the carrier includes dental benefits as part of the underlying benefit plan.
31.10.17.9999.htm 31.10.17.9999. Administrative History Effective date: July 12, 1998 (25:14 Md. R. 1132) ―. Chapter recodified from COMAR 09.31.26 to COMAR 31.10.17, July 1998.
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