Md. Code Regs. 31.10.16.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.10.16.02 - Definitions

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

B. Terms Defined.

(1) Carrier.

(a) "Carrier" means:

(i) An insurer;

(ii) A nonprofit health service plan;

(iii) A health maintenance organization;

(iv) A dental plan organization; and

(v) Any other person or organization that provides health benefit plans subject to State regulation.

(b) "Carrier" includes an entity that arranges a provider panel for a carrier.

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

(3) Provider Panel.

(a) "Provider panel" means those providers with which a carrier contracts to provide health care services to the carrier's enrollees under the carrier's health benefit plan.

(b) "Provider panel" does not include an arrangement between a carrier and providers in which a provider may participate solely on the basis of the provider's contracting with the carrier to provide services at a discounted fee-for-service rate.

Md. Code Regs. 31.10.16.02