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§ 15-10D-03. Obligations of carrier

MD Ins Code § 15-10D-03 (2019) (N/A)
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(a)    It is a violation of this subtitle for a carrier to fail to fulfill the carrier’s obligations to provide or reimburse for health care services specified in the carrier’s policies or contracts with members.

(b)    If, in rendering a coverage decision or appeal decision, a carrier fails to fulfill the carrier’s policies or contracts with members, the Commissioner may:

(1)    issue an administrative order that requires the carrier to:

(i)    cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier;

(ii)    fulfill the carrier’s contractual obligations;

(iii)    provide a health care service or payment that has been denied improperly; or

(iv)    take appropriate steps to restore the carrier’s ability to provide a health care service or payment that is provided under a contract; or

(2)    impose any penalty or fine or take any action as authorized:

(i)    for an insurer, nonprofit health service plan, or dental plan organization, under this article; or

(ii)    for a health maintenance organization, under the Health - General Article or under this article.

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§ 15-10D-02. Appeals
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§ 15-10D-04. Regulations