Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.01 - Health Maintenance Organizations - Certificate of Authority and Fiscal Requirements
Section 31.12.01.14 - Insurance - Catastrophic or Back-Up Coverage
Universal Citation: MD Code Reg 31.12.01.14
Current through Register Vol. 51, No. 19, September 20, 2024
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; and
(2) Reinsurance protection to the HMO in event of catastrophic or unusual losses which would be in excess of the levels of loss which the HMO assumes in the basis of its calculation of premium charges.
B. Any exemption to requirements of §A of this regulation shall be for a period of 1 year, and may be renewed from year to year thereafter. Any requests for renewal shall be made by the HMO at least 90 days before the expiration date of the then current exemption.
C. With the approval of the Commissioner, the HMO may reinsure any portion or aspect of its operation.
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