31.12.03.02

.02 Required Notice.

When a health maintenance organization is the sole carrier offered to group members by a group policyholder, the health maintenance organization:

A. Shall offer the group policyholder a point-of-service option for the individual group member to accept or reject;

B. May not impose a minimum participation level on the mandatory point-of-service option; and

C. As part of the application, shall provide to each group policyholder the following disclosure statement, for each point-of-service option offered:

“Under Maryland law, if you choose a point-of-service option for your group members, your group member may select a point-of-service option as an additional benefit. A point-of-service option allows your group members to obtain health care services from physicians and other providers outside the HMO network under certain circumstances that are described in attachment A. You have the choice to either pay for this point-of-service option, pay a percentage of the cost of this option, or require your group members to pay for the entire cost of this option. The cost of the point-ofservice option described in attachment A is identified in your proposal.

I have read and understand this disclosure statement and the attachments and, if I have chosen the point-of-service option, I will provide notice of the availability of this additional benefit to my eligible group members. Group Policyholder Signature”