Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 11 - HEALTH INSURANCE - GROUP
Chapter 31.11.06 - Comprehensive Standard Health Benefit Plan
Section 31.11.06.09 - Mandated Benefits

Universal Citation: MD Code Reg 31.11.06.09

Current through Register Vol. 51, No. 19, September 20, 2024

A. The plan excludes mandated benefits, except for Insurance Article, §§ 15-123(d), 15-401, 15-407, 15-408, 15-409, 15-412(a) -(h), 15-414, 15-604, 15-701, 15-811, 15-812, 15-815, 15-816, 15-823, 15-839, and 15-10B-09, Annotated Code of Maryland, and Health-General Article, §§19-703(d) and (g), 19-706(h), 19-710.1(b)(1)(ii), and 19-712.5, Annotated Code of Maryland, to the extent those sections are considered mandated benefits.

B. Notwithstanding the mandated benefits included in Regulation .09A of this chapter, the requirements of Insurance Article, § 15-812(g), Annotated Code of Maryland, relating to imposition of copayment, coinsurance, or deductibles, are inapplicable to a HSA-compatible delivery system.

C. These regulations do not exclude any requirement contained in statute or regulation that a carrier shall pay hospitals for hospital services rendered in accordance with rates approved by the Health Services Cost Review Commission.

D. A health maintenance organization shall include the conversion benefit required under COMAR 31.12.02.11B.

E. Referrals to Specialists. Each carrier:

(1) That does not allow direct access to specialists shall provide for a standing referral to a specialist under the requirements of Insurance Article, § 15-830, Annotated Code of Maryland;

(2) Shall provide for a referral to a specialist who is not part of the carrier's panel under the requirements of Insurance Article, § 15-830, Annotated Code of Maryland;

(3) [Shall] For plan years beginning before September 23, 2010, shall provide direct access to obstetric and gynecological care as specified in Insurance Article, § 15-816, Annotated Code of Maryland; and

(4) For plan years beginning on or after September 23, 2010, shall provide direct access to obstetric and gynecological care as specified in 45 CFR 147.138(a)(3).

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