Skip to Main Content
<< Back | Return to Main COMAR Search Page

16 records match your request.

FileAbstract
31.12.01.00.htm 31.12.01.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 12 HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS Chapter 01 Health Maintenance Organizations ― Certificate of Authority and Fiscal Requirements Authority: Health-General Article, §19-705(a) 19-707, 19-708, 19-710, and 19-728, Annotated Code of Maryland
31.12.01.01.htm 31.12.01.01. 01 Authority and Purpose.. The Insurance Commissioner adopts and promulgates this chapter according to Health-General Article, §19-705, Annotated Code of Maryland, for the purpose of governing and regulating various phases of the operations of health maintenance organizations.
31.12.01.02.htm 31.12.01.02. 02 Definitions.. A. All terms defined in the Health Maintenance Organization Act of 1975 which are used in this chapter have the same meaning as in the Act unless the terms are defined differently in this chapter.B. Terms Defined.. 1) "HMO" means a health maintenance organization.. 2) "Individual contract" means a contractual agreement for the provision of health care services on a prepaid basis entered into between an HMO and a subscriber, provided the contract covers only the
31.12.01.03.htm 31.12.01.03. 03 Scope.. The scope of this chapter is the scope of Health-General Article, Title 19, Subtitle 7, Annotated Code of Maryland, as it relates to the Insurance Commissioner.
31.12.01.04.htm 31.12.01.04. 04 Application for Certificate of Authority.. A. The Act provides that an HMO may not engage in business as an HMO unless so authorized under a certificate of authority issued by the Insurance Commissioner.B. Application for a certificate of authority shall be submitted by the HMO not less than 90 days before the date it proposes to engage in business in this State.C. An application form will be furnished by the Commissioner on the request of the HMO.. D. Each health maintenanc
31.12.01.05.htm 31.12.01.05. 05 Change of Ownership.. The HMO shall notify the Commissioner within 10 days of any transfer of ownership or more than an aggregate of 10 percent of the stock or ownership interest in the HMO occurring during any 12-month period.
31.12.01.06.htm 31.12.01.06. 06 Change of Name.. No name other than that approved by the Commissioner may be used. The name of the HMO may not be changed without prior approval of the Commissioner.
31.12.01.07.htm 31.12.01.07. 07 Filings, Forms, and Rates.. HMOs shall be subject to the applicable procedures and requirements for filings, forms, and rates as outlined in COMAR 31.12.02.
31.12.01.08.htm 31.12.01.08. 08 Repealed..
31.12.01.09.htm 31.12.01.09. 09 Marketing.. The manner of marketing health care contracts shall be fully set forth in writing by the HMO before licensing, and any substantive alterations in marketing procedures must be approved by the Commissioner before use.
31.12.01.10.htm 31.12.01.10. 10 Repealed..
31.12.01.11.htm 31.12.01.11. 11 Annual Report.. A. Each licensed health maintenance organization, unless the time is extended for good cause shown, shall file a report with the Commissioner, certified by an audit of a certified public accounting firm, showing its financial condition on the last day of the preceding calendar year. The report shall be on the form adopted by the Commissioner and shall annually be filed with the Commissioner on or before the first day of March. The report shall be
31.12.01.12.htm 31.12.01.12. 12 Fiscal Examination.. A. The Commissioner may make an examination of the operation of any health maintenance organization as often as the Commissioner deems necessary for the protection of the interest of the people of Maryland, but the examinations may not be less frequent than once every 5 years.B. The expense of each examination shall be assessed against the HMO being examined and the HMO shall remit the cost of the examination to the Commissioner.
31.12.01.13.htm 31.12.01.13. 13 Repealed..
31.12.01.14.htm 31.12.01.14. 14 Insurance ― Catastrophic or Back-Up Coverage.. A. Unless the Commissioner grants an exemption from the requirements of this section, the HMO shall secure insurance coverage to provide:1) Payments or services required to be made or furnished under the health care contract to those enrollees who are injured or become ill outside the geographic limits served by the HMO; and2) Reinsurance protection to the HMO in event of catastrophic or unusual losses which would be in ex
31.12.01.9999.htm 31.12.01.9999. Administrative History Effective date: October 1, 1977 (4:18 Md. R. 1422). Regulation .02A and C amended effective August 5, 1991 (18:15 Md. R. 1725). Regulation .02D―F adopted effective August 5, 1991 (18:15 Md. R. 1725). Regulation .02D amended effective November 9, 1992 (19:22 Md. R. 1988). Regulation .04G, H, and K amended effective August 5, 1991 (18:15 Md. R. 1725). Regulation .04K adopted effective June 29, 1987 (14:13 Md. R. 1472).
<< Back | Return to Main COMAR Search Page