Md. Code Regs. 31.10.34.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.34.03 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Accredited hospital" means a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations.

(2) "Carrier" means an insurer, a nonprofit health service plan, or a dental plan organization.

(3) "Enrollee" means an individual entitled to health care benefits from a carrier.

(4) "Hospital-based physician" means an anesthesiologist, pathologist, radiologist, neonatologist, hospitalist, intensivist, or emergency medicine physician that practices exclusively within an accredited hospital and provides care to enrollees only as a result of the enrollees being directed to the hospital.

(5) "Prominent carrier" means a carrier reporting at least $90,000,000 in written premium for medical benefits in Maryland in the most recent annual statement.

(6) "Provider" means a health care practitioner or group of health care practitioners licensed, certified, or otherwise authorized by law to provide health care services.

(7) "Provider panel" means the providers that contract either directly or through a subcontracting entity with a carrier to provide health care services to the carrier's enrollees under the carrier's health benefit plan.

Md. Code Regs. 31.10.34.03