Md. Code Regs. 31.10.41.02

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

Section 31.10.41.02 - Definitions

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

B. Terms Defined.

(1) "Allowed amount" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(2) "Assignment of benefits" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(3) "Carrier" means an insurer or nonprofit health service plan.

(4) "Covered service" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(5) "Explanation of benefits" means the document that is provided by a carrier to an insured that explains the claims paid, reduced, or denied by the carrier.

(6) "Hospital-based physician" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland and does not include an on-call physician.

(7) "Insured" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(8) "Insurer" has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(9) "Nonpreferred provider" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(10) "Nonprofit health service plan" means a person who has a certificate of authority to operate as a nonprofit health service plan in Maryland.

(11) "On-call physician" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(12) "Preferential basis" has the meaning stated in Insurance Article, § 14-201, Annotated Code of Maryland.

(13) "Preferred provider insurance policy" means a policy or insurance contract issued or delivered in the State by a carrier under which health care services furnished by a preferred provider are paid on a preferential basis.

Md. Code Regs. 31.10.41.02