Md. Code Regs. 31.11.06.09

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

Section 31.11.06.09 - Mandated Benefits

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).

Md. Code Regs. 31.11.06.09

Regulation .09A amended as an emergency provision effective June 1, 1996 (23:13 Md. R. 937); emergency status extended at 23:18 Md. R. 1313; emergency status expired January 16, 1997
Regulation .09A amended effective March 10, 1997 (24:5 Md. R. 407)
Regulation .09A amended as an emergency provision effective October 1, 1997 (24:21 Md. R. 1441); amended permanently effective January 12, 1998 (25:1 Md. R. 15)
Regulation .09A amended as an emergency provision effective December 31, 1997 (25:2 Md. R. 73); amended permanently effective April 6, 1998 (25:7 Md. R. 527)
Regulation .09A amended effective May 18, 1998 (25:10 Md. R. 746)
Regulation .09 amended as an emergency provision effective May 21, 2004 (31:12 Md. R. 909); amended permanently effective August 16, 2004 (31:16 Md. R. 1257)
Regulation .09A amended effective March 18, 2002 (29:5 Md. R. 506); April 20, 2009 (36:8 Md. R. 598)
Regulation .09B amended effective April 10, 2006 (33:7 Md. R. 676)
Regulation .09D adopted as an emergency provision effective October 1, 1999 (26:22 Md. R. 1689); emergency status expired February 1, 2000
Regulation .09D adopted effective February 7, 2000 (27:2 Md. R. 148)
Regulation .09D amended effective February 5, 2001 (28:2 Md. R. 106); April 10, 2006 (33:7 Md. R. 676)
Regulation .09E amended as an emergency provision effective September 23, 2010 (37:23 Md. R. 1608); amended permanently effective January 13, 2011 (38:1 Md. R. 13)