2016 Maryland Code
Title 15 - Health Insurance
Subtitle 10 - Claims and Utilization Review
§ 15-1007. Summary explanation of benefits

MD Ins Code § 15-1007 (2016) What's This?

(a) Scope of section. -- This section applies to insurers and nonprofit health service plans that propose to issue or deliver individual, group, or blanket health insurance policies or contracts or to administer health benefit programs that provide hospital, medical, or surgical benefits on an expense-incurred basis.

(b) Required. -- Each entity subject to this section shall provide to an insured individual who has filed a claim described in subsection (c) of this section an annual summary explanation of benefits that covers the preceding 12-month period.

(c) Contents. -- The summary explanation of benefits required under subsection (b) of this section shall provide a summary of:

(1) all claims filed by health care providers for services rendered to the insured individual or covered dependent of the insured individual during an inpatient hospitalization or an outpatient surgical procedure;

(2) the amount paid by the entity for each claim filed; and

(3) the balance owed by the insured individual for each claim filed.

(d) Explanation of benefits subject to federal Health Insurance Portability and Accountability Act. -- The explanation of benefits required under this section is subject to 45 C.F.R. ยง 164.522(b).

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