Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 11 - HEALTH INSURANCE - GROUP
Chapter 31.11.12 - Limited Benefit Plan
Section 31.11.12.08 - Mandated Benefits
Universal Citation: MD Code Reg 31.11.12.08
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) and (h), 15-414, 15-604, 15-701, 15-811, 15-812, 15-815, 15-816, and 15-10B-09, Annotated Code of Maryland, and Health-General Article, §§19-703(d) and (g), and 19-706(h), Annotated Code of Maryland, to the extent those sections are considered mandated benefits.
B. This chapter does 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.
C. 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; and
(3) Shall provide direct access to obstetric and gynecological care as specified in Insurance Article, §
15-816, Annotated Code of Maryland.
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