Statutes, codes, and regulations
Maryland Administrative code
Title 31 - MARYLAND INSURANCE ADMINISTRATIONSubtitle 17 - MARYLAND HEALTH INSURANCE PLAN
Chapter 31.17.03 - Operation and Administration of the Plan
Section 31.17.03.19 - Complaints

Md. Code Regs. 31.17.03.19

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Current through Register Vol. 51, No. 21, October 18, 2024
Section 31.17.03.19 - Complaints
A. The Plan administrator shall comply with the complaint process for adverse decisions and grievance decisions in Insurance Article, Title 15, Subtitle 10A, Annotated Code of Maryland.
B. The Plan administrator shall comply with the complaint process for coverage decisions in Insurance Article, Title 15, Subtitle 10D, Annotated Code of Maryland.
C. Members and providers shall have the same appeal rights regarding denials under the Plan as found under Insurance Article, Title 15, Subtitles 10A and 10D, Annotated Code of Maryland.
D. Complaints Regarding Eligibility Denials.
(1) An individual shall file any initial complaints regarding an eligibility denial with the Plan administrator.
(2) If the Plan administrator upholds its initial denial regarding an individual's eligibility for Plan coverage, the individual may appeal this denial to the Board or its designee.

Md. Code Regs. 31.17.03.19

Regulations .19 adopted as an emergency provision effective April 8, 2003 (30:9 Md. R. 609); emergency text amended effective July 1, 2003 (30:16 Md. R. 1072); adopted permanently effective December 22, 2003 (30:25 Md. R. 1851)