Md. Code Regs. 31.11.12.08

Current through Register Vol. 51, No. 12, June 14, 2024

Section 31.11.12.08 - 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) 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.

Md. Code Regs. 31.11.12.08