<section article="gin" article_name="Insurance" number="14-101" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Health care provider” means a chiropractor, dentist, hospital, optometrist, pharmacist, physician, podiatrist, or psychologist.</text> </level> <level label="c"> <text>“Health care services” means chiropractic, dental, hospital, medical, optometric, pharmaceutical, podiatric, or psychological services.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-102" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>The purpose of this subtitle is:</text> <level label="1"> <text>to regulate the formation and operation of nonprofit health service plans in the State; and</text> </level> <level label="2"> <text>to promote the formation and existence of nonprofit health service plans in the State that:</text> <level label="i"> <text>are committed to a nonprofit corporate structure;</text> </level> <level label="ii"> <text>seek to provide individuals, businesses, and other groups with affordable and accessible health insurance; and</text> </level> <level label="iii"> <text>recognize a responsibility to contribute to the improvement of the overall health status of the residents of the jurisdictions in which the nonprofit health service plans operate.</text> </level> </level> </level> <level label="b"> <text>A nonprofit health service plan that complies with the provisions of this subtitle is declared to be a public benefit corporation that is exempt from taxation as provided by law.</text> </level> <level label="c"> <text>The mission of a nonprofit health service plan shall be, in accordance with the charter of the nonprofit health service plan, to:</text> <level label="1"> <text>provide affordable and accessible health insurance to the plan’s insureds and those persons insured or issued health benefit plans by affiliates or subsidiaries of the plan;</text> </level> <level label="2"> <text>assist and support public and private health care initiatives for individuals without health insurance; and</text> </level> <level label="3"> <text>promote the integration of a health care system that meets the health care needs of all the residents of the jurisdictions in which the nonprofit health service plan operates.</text> </level> </level> <level label="d"> <text>A nonprofit health service plan shall develop goals, objectives, and strategies for carrying out, in accordance with the charter of the nonprofit health service plan, its statutory mission.</text> </level> <level label="e"> <text>On or before May 31, 2015, and annually thereafter, the Commissioner shall report to the Governor and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee and the House Health and Government Operations Committee on the compliance of a nonprofit health service plan subject to § 14–115(d) of this subtitle with the provisions of this subtitle.</text> </level> <level label="f"> <level label="1"> <text>Subject to paragraph (2) of this subsection, this section applies to:</text> <level label="i"> <text>a nonprofit health service plan that is issued a certificate of authority in the State, whether or not organized under the laws of the State; and</text> </level> <level label="ii"> <text>an insurer or a health maintenance organization, whether or not organized as a nonprofit corporation, that is wholly owned or controlled by a nonprofit health service plan that:</text> <level label="1"> <text>is issued a certificate of authority in the State; and</text> </level> <level label="2"> <text>does business in the State.</text> </level> </level> </level> <level label="2"> <text>To the extent that the legislatively enacted charter of an entity subject to this section, or the laws or administrative rules or regulations of the jurisdiction of domicile of an entity subject to this section, prohibit the entity from complying with a requirement of subsection (c) of this section, the legislatively enacted charter, laws, and administrative rules and regulations of the jurisdiction of domicile shall supersede and take precedence over the requirement of subsection (c) of this section.</text> </level> </level> <level label="g"> <text>A corporation without capital stock organized for the purpose of establishing, maintaining, and operating a nonprofit health service plan through which health care providers provide health care services to subscribers to the plan under contracts that entitle each subscriber to certain health care services shall be governed and regulated by:</text> <level label="1"> <text>this subtitle;</text> </level> <level label="2"> <text>Title 2, Subtitle 2 of this article and §§ 1–206, 3–127, and 12–210 of this article;</text> </level> <level label="3"> <text>Title 2, Subtitle 5 of this article;</text> </level> <level label="4"> <text>§§ 4–113, 4–114, and 4–503 of this article;</text> </level> <level label="5"> <text>Title 5, Subtitles 1, 2, 3, 4, and 5 of this article;</text> </level> <level label="6"> <text>Title 7 of this article, except for § 7–706 and Subtitle 2 of Title 7;</text> </level> <level label="7"> <text>Title 9, Subtitles 1, 2, and 4 of this article;</text> </level> <level label="8"> <text>Title 10, Subtitle 1 of this article;</text> </level> <level label="9"> <text>Title 27 of this article;</text> </level> <level label="10"> <text>Title 33 of this article; and</text> </level> <level label="11"> <text>any other provision of this article that:</text> <level label="i"> <text>is expressly referred to in this subtitle;</text> </level> <level label="ii"> <text>expressly refers to this subtitle; or</text> </level> <level label="iii"> <text>expressly refers to nonprofit health service plans or persons subject to this subtitle.</text> </level> </level> </level> <level label="h"> <text>The provisions of subsections (d) and (e) of this section and §§ 14–106, 14–106.1, 14–115(d), (e), (f), and (g), and 14–139(d) and (e) of this subtitle do not apply to a nonprofit health service plan that insures between 1 and 10,000 covered lives in Maryland or issues contracts for only one of the following services:</text> <level label="1"> <text>podiatric;</text> </level> <level label="2"> <text>chiropractic;</text> </level> <level label="3"> <text>pharmaceutical;</text> </level> <level label="4"> <text>dental;</text> </level> <level label="5"> <text>psychological; or</text> </level> <level label="6"> <text>optometric.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-103" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>Each nonprofit health service plan shall disclose on each document, statement, announcement, and advertisement and in any representation it places before the public that the nonprofit health service plan is a private nonprofit corporation.</text> </section> <section article="gin" article_name="Insurance" number="14-104" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>Each nonprofit health service plan that provides hospital benefits shall furnish a statement of the plan’s principal claims practices as part of the certificate form or booklet describing the coverage to be afforded.</text> </level> <level label="b"> <text>The statement shall include practices for payment for:</text> <level label="1"> <text>surgical procedures performed by two or more surgeons;</text> </level> <level label="2"> <text>services provided in-area by nonparticipating providers; and</text> </level> <level label="3"> <text>services provided out-of-area by affiliated plans and affiliated providers.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-105" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>If a nonprofit health service plan is successful in an action against a person authorized to provide health care in the State, the nonprofit health service plan may recover the costs and expenses reasonably incurred by it in the action if it shows that:</text> <level label="1"> <text>the person knowingly or willfully made or caused to be made:</text> <level label="i"> <text>a false statement or representation of a material fact in an application for a benefit or payment from a nonprofit health service plan under this subtitle or Title 15 of this article;</text> </level> <level label="ii"> <text>a false statement or representation of a material fact for use in determining rights to those benefits or payments; or</text> </level> <level label="iii"> <text>a false statement or representation about a procedure, operation, or service alleged to have been performed; or</text> </level> </level> <level label="2"> <text>the person:</text> <level label="i"> <text>engaged in gross, willful, and continued overcharging for a procedure, operation, or service; or</text> </level> <level label="ii"> <text>filed false statements for collection of fees for services that were not rendered.</text> </level> </level> </level> <level label="b"> <text>If a nonprofit health service plan is denied relief in an action under this section, the person against whom the action was brought may recover the costs and expenses reasonably incurred by the person in defending the action.</text> </level> <level label="c"> <text>This section does not limit any additional rights or remedies that a nonprofit health service plan may have at law or in equity.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-106" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>It is the public policy of this State that the exemption from taxation for nonprofit health service plans under § 6–101(b)(1) of this article is granted so that funds which would otherwise be collected by the State and spent for a public purpose shall be used in a like manner and amount by the nonprofit health service plan.</text> </level> <level label="b"> <text>By March 1 of each year or a deadline otherwise imposed by the Commissioner for good cause, each nonprofit health service plan shall file with the Commissioner a premium tax exemption report that:</text> <level label="1"> <text>is in a form approved by the Commissioner; and</text> </level> <level label="2"> <text>demonstrates that the plan has used funds equal to the value of the premium tax exemption provided to the plan under § 6–101(b) of this article, in a manner that serves the public interest in accordance with this section.</text> </level> </level> <level label="c"> <text>A nonprofit health service plan may satisfy the public service requirement of this section by establishing that, to the extent the value of the nonprofit health service plan’s premium tax exemption under § 6–101(b) of this article exceeds the subsidy required under the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health – General Article, the plan has:</text> <level label="1"> <text>increased access to, or the affordability of, one or more health care products or services by offering and selling health care products or services that are not required or provided for by law;</text> </level> <level label="2"> <text>provided financial or in–kind support for public health programs;</text> </level> <level label="3"> <text>employed underwriting standards in a manner that increases the availability of one or more health care services or products;</text> </level> <level label="4"> <text>employed pricing policies that enhance the affordability of health care services or products and result in a higher medical loss ratio than that established by a comparable for–profit health insurer; or</text> </level> <level label="5"> <text>served the public interest by any method or practice approved by the Commissioner.</text> </level> </level> <level label="d"> <level label="1"> <text>Notwithstanding subsection (c) of this section, a nonprofit health service plan that is subject to this section and issues comprehensive health care benefits in the State shall:</text> <level label="i"> <text>offer health care products in the individual market;</text> </level> <level label="ii"> <text>offer health care products in the small employer group market in accordance with Title 15, Subtitle 12 of this article;</text> </level> <level label="iii"> <text>subsidize the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health – General Article;</text> </level> <level label="iv"> <text>subsidize the Kidney Disease Program under Title 13, Subtitle 3 of the Health – General Article;</text> </level> <level label="v"> <text>support the costs of the Community Health Resources Commission under Title 19, Subtitle 21 of the Health – General Article, including:</text> <level label="1"> <text>operating grants to community health resources;</text> </level> <level label="2"> <text>funding for a unified data information system;</text> </level> <level label="3"> <text>the documented direct costs of fulfilling the statutory and regulatory duties of the Commission; and</text> </level> <level label="4"> <text>the administrative costs of the Commission; and</text> </level> </level> <level label="vi"> <text>subsidize the provision of mental health services to the uninsured under Title 10, Subtitle 2 of the Health – General Article.</text> </level> </level> <level label="2"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, the support provided under paragraph (1)(iv), (v), and (vi) of this subsection to the Kidney Disease Program, the Community Health Resources Commission, and the Maryland Department of Health, respectively, shall be the value of the premium tax exemption less the subsidy required under this subsection for the Senior Prescription Drug Assistance Program.</text> </level> <level label="ii"> <text>The subsidy provided under this subsection to the Community Health Resources Commission may not be less than:</text> <level label="1"> <text>$3,000,000 for each of fiscal years 2012 and 2013; and</text> </level> <level label="2"> <text>$8,000,000 for each of fiscal years 2014 through 2022.</text> </level> </level> </level> <level label="3"> <text>For any year, the subsidy and funding required under this subsection by a nonprofit health service plan subject to this section may not exceed the value of the nonprofit health service plan’s premium tax exemption under § 6–101(b) of this article.</text> </level> </level> <level label="e"> <text>The subsidy that a nonprofit health service plan is required to provide to the Senior Prescription Drug Assistance Program under subsection (d)(1)(iii) of this section:</text> <level label="1"> <text>for the period of January 1, 2006 through June 30, 2006, may not exceed $8,000,000;</text> </level> <level label="2"> <text>for fiscal years 2008 through 2021, may not exceed $14,000,000;</text> </level> <level label="3"> <text>for fiscal year 2022, may not exceed $14,000,000; and</text> </level> <level label="4"> <text>for any year after fiscal year 2022, may not exceed the value of the nonprofit health service plan’s premium tax exemption under § 6–101(b) of this article.</text> </level> </level> <level label="f"> <level label="1"> <text>Subject to paragraph (2) of this subsection, each report filed with the Commissioner under subsection (b) of this section is a public record.</text> </level> <level label="2"> <text>In accordance with § 4–335 of the General Provisions Article, the Commissioner shall deny inspection of any part of a report filed under subsection (b) of this section that the Commissioner determines contains confidential commercial information or confidential financial information.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-106.1" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>Beginning in fiscal year 2006, a nonprofit health service plan shall transfer funds in the amounts provided under § 14–106(d)(2) of this subtitle to:</text> <level label="1"> <text>the Community Health Resources Commission Fund established under § 19–2201 of the Health – General Article to support the costs of the Community Health Resources Commission as provided in § 14–106(d)(1)(v) of this subtitle;</text> </level> <level label="2"> <text>the Maryland Department of Health for the Kidney Disease Program under Title 13, Subtitle 3 of the Health – General Article; and</text> </level> <level label="3"> <text>the Maryland Department of Health for the provision of mental health services to the uninsured under Title 10, Subtitle 2 of the Health – General Article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-107" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>By November 1 of each year, the Commissioner shall issue an order notifying each nonprofit health service plan that is required to file a report under § 14–106 of this subtitle of whether the plan has satisfied the requirements of § 14–106 of this subtitle.</text> </level> <level label="b"> <text>If the Commissioner determines that a nonprofit health service plan has not satisfied the requirements of § 14–106 of this subtitle, the Commissioner shall issue an order requiring the nonprofit health service plan to pay the premium tax under Title 6, Subtitle 1 of this article:</text> <level label="1"> <text>for a period of time beginning with the date the plan was determined to be out of compliance with § 14–106 of this subtitle; and</text> </level> <level label="2"> <text>in an amount equal to the amount by which the value of the nonprofit health service plan’s premium tax exemption under § 6–101(b) of this article exceeds the sum of:</text> <level label="i"> <text>the subsidy required under the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health – General Article; and</text> </level> <level label="ii"> <text>other funds used by the nonprofit health service plan to meet the public service requirement under § 14–106 of this subtitle.</text> </level> </level> </level> <level label="c"> <text>A nonprofit health service plan that fails to timely file the report required under § 14–106 of this subtitle shall pay the penalties under § 14–121 of this subtitle.</text> </level> <level label="d"> <text>A party aggrieved by an order of the Commissioner issued under this section has a right to a hearing in accordance with §§ 2–210 through 2–215 of this article.</text> </level> <level label="e"> <text>Premium tax revenue collected by the Administration as the result of an order issued under subsection (b) of this section shall be deposited into the Senior Prescription Drug Assistance Program Fund established under § 15–1004 of the Health – General Article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-108" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>A corporation subject to this subtitle may not issue contracts for the rendering of health care services to subscribers unless the Commissioner has issued a certificate of authority to the corporation authorizing it to do so.</text> </section> <section article="gin" article_name="Insurance" number="14-109" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>An applicant for a certificate of authority shall:</text> <level label="1"> <text>file with the Commissioner an application on the form that the Commissioner provides containing the information that the Commissioner considers necessary;</text> </level> <level label="2"> <text>pay to the Commissioner the applicable fee required by § 2-112 of this article; and</text> </level> <level label="3"> <text>file with the Commissioner copies of the following documents, certified by at least two of the executive officers of the corporation:</text> <level label="i"> <text>articles of incorporation, including the applicant’s corporate mission statement, with all amendments;</text> </level> <level label="ii"> <text>bylaws with all amendments;</text> </level> <level label="iii"> <text>each contract executed or proposed to be executed by the corporation and a health care provider, embodying the terms under which health care services are to be furnished to subscribers to the plan;</text> </level> <level label="iv"> <text>each form of contract issued or proposed to be issued to subscribers to the plan and a table of the rates charged or proposed to be charged to subscribers for each form of contract;</text> </level> <level label="v"> <text>a financial statement of the corporation, including the amount of each contribution paid or agreed to be paid to the corporation for working capital, the name of each contributor, and the terms of each contribution;</text> </level> <level label="vi"> <text>a list of the names and addresses of and biographical information about the members of the board of directors of the corporation;</text> </level> <level label="vii"> <text>a list of the total compensation paid or proposed to be paid to each officer and member of the board of directors of the corporation;</text> </level> <level label="viii"> <text>a list of the beginning and ending terms of membership for each member of the board of directors of the corporation; and</text> </level> <level label="ix"> <text>any other information or documents that the Commissioner considers necessary to ensure compliance with this subtitle.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-110" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>The Commissioner shall issue a certificate of authority to an applicant if:</text> <level label="1"> <text>the applicant has paid the applicable fee required by § 2-112 of this article; and</text> </level> <level label="2"> <text>the Commissioner is satisfied:</text> <level label="i"> <text>that the applicant has been organized in good faith for the purpose of establishing, maintaining, and operating a nonprofit health service plan that:</text> <level label="1"> <text>is committed to a nonprofit corporate structure;</text> </level> <level label="2"> <text>in accordance with the charter of the nonprofit health service plan, seeks to provide affordable and accessible health insurance; and</text> </level> <level label="3"> <text>in accordance with the charter of the nonprofit health service plan, recognizes a responsibility to contribute to the improvement of the overall health status of the residents of the jurisdictions in which it operates;</text> </level> </level> <level label="ii"> <text>that:</text> <level label="1"> <text>each contract executed or proposed to be executed by the applicant and a health care provider to furnish health care services to subscribers to the nonprofit health service plan, obligates or, when executed, will obligate each health care provider party to the contract to render the health care services to which each subscriber is entitled under the terms and conditions of the various contracts issued or proposed to be issued by the applicant to subscribers to the plan; and</text> </level> <level label="2"> <text>each subscriber is entitled to reimbursement for podiatric, chiropractic, psychological, or optometric services, regardless of whether the service is performed by a licensed physician, licensed podiatrist, licensed chiropractor, licensed psychologist, or licensed optometrist;</text> </level> </level> <level label="iii"> <text>that:</text> <level label="1"> <text>each contract issued or proposed to be issued to subscribers to the plan is in a form approved by the Commissioner; and</text> </level> <level label="2"> <text>the rates charged or proposed to be charged for each form of each contract are fair and reasonable;</text> </level> </level> <level label="iv"> <text>that the applicant has a surplus, as defined in § 14-117 of this subtitle, of the greater of:</text> <level label="1"> <text>$100,000; and</text> </level> <level label="2"> <text>an amount equal to that required under § 14-117 of this subtitle; and</text> </level> </level> <level label="v"> <text>that, except for a nonprofit health service plan that insures between 1 and 10,000 covered lives in the State, the nonprofit health service plan’s corporate headquarters is located in the State.</text> </level> </level> </level> <level label="b"> <text>If the Commissioner determines that a nonprofit health service plan does not continue to satisfy the requirements of this subtitle, the Commissioner may disapprove the renewal of the certificate of authority of the nonprofit health service plan.</text> </level> <level label="c"> <text>The Commissioner shall consider an entity’s inability to comply with the requirements of § 14-102(c) of this subtitle as a result of a conflict with the legislatively enacted charter of the entity or the laws or administrative rules or regulations of the jurisdiction of domicile of the entity in determining whether to issue or renew a certificate of authority under this section.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-111" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>Subject to the authority of the Commissioner to regulate nonprofit health service plans under this article, a certificate of authority issued under this subtitle authorizes a corporation to:</text> <level label="1"> <text>issue contracts in the form filed with the Commissioner to persons that become subscribers to the plan;</text> </level> <level label="2"> <text>finance capital improvement projects through the Maryland Health and Higher Educational Facilities Authority as provided under Title 10, Subtitle 3 of the Economic Development Article;</text> </level> <level label="3"> <text>finance capital improvement projects through the Maryland Economic Development Corporation as provided under Title 10, Subtitle 1 of the Economic Development Article; and</text> </level> <level label="4"> <text>partner with the State and other public or private entities to provide services or administer programs intended to address community health care needs.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-112" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>The Commissioner may revoke a certificate of authority issued to a corporation subject to this subtitle, and at any time after revocation may institute proceedings under Title 9, Subtitle 2 of this article to rehabilitate or liquidate the corporation, if:</text> <level label="1"> <text>grounds exist under § 4-113 of this article; or</text> </level> <level label="2"> <text>the Commissioner has reason to believe that the corporation:</text> <level label="i"> <text>is being operated for profit;</text> </level> <level label="ii"> <text>is being fraudulently conducted;</text> </level> <level label="iii"> <text>is not complying with this subtitle or article;</text> </level> <level label="iv"> <text>knowingly is failing to comply with a rule, regulation, or order of the Commissioner; or</text> </level> <level label="v"> <text>has violated the provisions of Title 6.5 of the State Government Article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-115" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Board” means the board of directors of a nonprofit health service plan.</text> </level> <level label="3"> <text>“Immediate family member” means a spouse, child, child’s spouse, parent, spouse’s parent, sibling, or sibling’s spouse.</text> </level> </level> <level label="b"> <text>This section applies to a nonprofit health service plan that is:</text> <level label="1"> <text>issued a certificate of authority in the State; and</text> </level> <level label="2"> <text>organized under the laws of the State.</text> </level> </level> <level label="c"> <level label="1"> <text>The business and affairs of a nonprofit health service plan shall be managed under the direction of a board of directors.</text> </level> <level label="2"> <level label="i"> <text>The board and its individual members are fiduciaries and shall act:</text> <level label="1"> <text>in good faith;</text> </level> <level label="2"> <text>in a manner that is reasonably believed to be in the best interests of the corporation and its controlled affiliates or subsidiaries that offer health benefit plans;</text> </level> <level label="3"> <text>in a manner that is reasonably believed to be in furtherance of the mission of the corporation as a nonprofit health service plan as required under § 14-102(c) of this subtitle; and</text> </level> <level label="4"> <text>with the care that an ordinarily prudent person in a like position would use under similar circumstances.</text> </level> </level> <level label="ii"> <text>The board and its individual members may not use board membership for personal or financial enrichment to the detriment of the nonprofit health service plan or the mission of the nonprofit health service plan.</text> </level> </level> <level label="3"> <text>The principal functions of the board shall include:</text> <level label="i"> <text>ensuring that the corporation effectively carries out the nonprofit mission established under § 14-102(c) of this subtitle;</text> </level> <level label="ii"> <text>selecting corporate management and evaluating its performance;</text> </level> <level label="iii"> <text>ensuring to the extent practicable that human resources and other resources are sufficient to meet corporate objectives;</text> </level> <level label="iv"> <text>subject to the provisions of subsection (d) of this section, nominating and selecting suitable candidates for the board;</text> </level> <level label="v"> <text>establishing a system of governance at the board level, including an annual evaluation of board performance; and</text> </level> <level label="vi"> <text>before considering any bid or offer to acquire the nonprofit health service plan and to convert to a for-profit entity under Title 6.5 of the State Government Article, ensuring that adequate consideration is given to an independent valuation of the nonprofit health service plan.</text> </level> </level> <level label="4"> <text>Each member of the board shall demonstrate a commitment to the mission of the nonprofit health service plan as required by § 14-102(c) of this subtitle.</text> </level> <level label="5"> <text>An officer or employee of a nonprofit health service plan or any of its affiliates or subsidiaries may not be appointed or elected to the board.</text> </level> <level label="6"> <text>A nonprofit health service plan is subject to the provisions of § 2-419 of the Corporations and Associations Article.</text> </level> </level> <level label="d"> <level label="1"> <text>This subsection applies to a corporation that is:</text> <level label="i"> <text>issued a certificate of authority as a nonprofit health service plan; and</text> </level> <level label="ii"> <text>the sole member of a corporation issued a certificate of authority as a nonprofit health service plan.</text> </level> </level> <level label="2"> <text>The board shall be composed of at least 11 members and no more than 23 members, including:</text> <level label="i"> <text>one nonvoting member, who is not a member of the Maryland General Assembly, appointed by and serving at the pleasure of the President of the Senate of Maryland;</text> </level> <level label="ii"> <text>one nonvoting member, who is not a member of the Maryland General Assembly, appointed by and serving at the pleasure of the Speaker of the House of Delegates; and</text> </level> <level label="iii"> <text>no more than 21 voting members selected by the board, in accordance with the bylaws of the corporation, including three consumer members, who are covered by the nonprofit health service plan or its affiliates at the time of their initial election to the board and who satisfy the requirements of paragraphs (13), (14), and (15) of this subsection.</text> </level> </level> <level label="3"> <text>No more than five members of the board may be:</text> <level label="i"> <text>licensed health care professionals;</text> </level> <level label="ii"> <text>hospital administrators; or</text> </level> <level label="iii"> <text>employees of health care professionals or hospitals.</text> </level> </level> <level label="4"> <text>To the extent possible, the board shall seek to include individuals with a diverse range of experience relevant to the mission of the corporation as a nonprofit health service plan as required under § 14–102 of this subtitle, including experience in data, consumer experience, government programs, population health, geriatrics, diversity, equity and inclusion, audit, human resources, benefit consulting, executive level, actuarial, accounting, information technology, finance, law, large and small businesses, nonprofit businesses, and organized labor.</text> </level> <level label="5"> <text>Except for nonvoting members under paragraph (2)(i) and (ii) of this subsection, the board shall be self–perpetuating.</text> </level> <level label="6"> <text>The board shall have the following standing committees whose duties shall include:</text> <level label="i"> <text>an audit committee responsible for ensuring financial accountability;</text> </level> <level label="ii"> <text>a finance committee responsible for reviewing and making recommendations on the annual budget and for developing and recommending long–range financial objectives;</text> </level> <level label="iii"> <text>a compensation committee responsible for developing proposed compensation guidelines in accordance with § 14–139(d) of this subtitle;</text> </level> <level label="iv"> <text>a nominating committee responsible for identifying, evaluating, and recommending to the board individuals qualified to become board members, including individuals who represent a corporation for which the nonprofit health service plan is the sole member;</text> </level> <level label="v"> <text>a service and quality oversight committee responsible for ensuring that policies and processes are in effect to assess and improve the quality of health insurance products provided to subscribers and certificate holders;</text> </level> <level label="vi"> <text>a mission oversight committee responsible for ensuring that the officers of the corporation act in accordance with the mission of the nonprofit health service plan;</text> </level> <level label="vii"> <text>a strategic planning committee responsible for examining long–range planning objectives, assessing strategies that may be used to implement the planning objectives, and analyzing the nonprofit health service plan’s role in the insurance marketplace; and</text> </level> <level label="viii"> <text>any other committee that the board determines is necessary to carry out its duties.</text> </level> </level> <level label="7"> <text>Each standing committee shall have representation from:</text> <level label="i"> <text>the voting members under paragraph (2) of this subsection; and</text> </level> <level label="ii"> <text>each corporation for which the nonprofit health service plan is the sole member.</text> </level> </level> <level label="8"> <text>The compensation committee and the nominating committee shall each include either the appointee of the President of the Senate or the appointee of the Speaker of the House of Delegates.</text> </level> <level label="9"> <text>Each board member shall serve on at least one standing committee.</text> </level> <level label="10"> <text>The chairman of the board shall select a chairman for each board committee.</text> </level> <level label="11"> <level label="i"> <text>The board shall approve in advance any action by the nonprofit health service plan, a corporation for which the plan is the sole member, or any affiliate or subsidiary of the nonprofit health service plan to:</text> <level label="1"> <text>materially modify options available in benefit plans marketed in the State;</text> </level> <level label="2"> <text>materially modify Maryland provider networks or Maryland provider reimbursement levels;</text> </level> <level label="3"> <text>materially modify underwriting guidelines for products marketed in the State;</text> </level> <level label="4"> <text>materially modify rates or rating plans that are required to be approved by the Commissioner;</text> </level> <level label="5"> <text>add a product to or withdraw a product from the Maryland market, withdraw from a line or type of business in the State, or withdraw from a geographic region in the State;</text> </level> <level label="6"> <text>materially modify marketing goals and objectives in the State; or</text> </level> <level label="7"> <text>materially impact the availability or affordability of health care in the State.</text> </level> </level> <level label="ii"> <text>The Commissioner shall adopt regulations that define “material” for purposes of subparagraph (i) of this paragraph.</text> </level> <level label="iii"> <text>A decision by the board to convert to a for–profit entity under Title 6.5 of the State Government Article may be rejected by any three members of the board.</text> </level> <level label="iv"> <text>The board may delegate approval for the actions listed in subparagraph (i) of this paragraph to a standing committee of the board.</text> </level> </level> <level label="12"> <text>The board shall take and retain complete minutes of all board and committee meetings.</text> </level> <level label="13"> <text>The three consumer members shall be either subscribers or certificate holders of the nonprofit health service plan or its affiliates at the time of their initial election to the board.</text> </level> <level label="14"> <text>Each consumer member of the board:</text> <level label="i"> <text>shall be a member of the general public;</text> </level> <level label="ii"> <text>may not be considered an agent or employee of the State for any purpose; and</text> </level> <level label="iii"> <text>is entitled to the same rights, powers, and privileges as the other members of the board.</text> </level> </level> <level label="15"> <text>A consumer member of the board may not:</text> <level label="i"> <text>be a licensee of or otherwise be subject to regulation by the Commissioner;</text> </level> <level label="ii"> <text>be employed by or have a financial interest in:</text> <level label="1"> <text>a nonprofit health service plan or its affiliates or subsidiaries; or</text> </level> <level label="2"> <text>a person regulated under this article or the Health – General Article; or</text> </level> </level> <level label="iii"> <text>within 3 years before appointment, have been employed by, had a financial interest in, or have received compensation from:</text> <level label="1"> <text>a nonprofit health service plan or its affiliates or subsidiaries; or</text> </level> <level label="2"> <text>a person regulated under this article or the Health – General Article.</text> </level> </level> </level> </level> <level label="e"> <level label="1"> <text>This subsection does not apply to a board that has fewer than three authorized members.</text> </level> <level label="2"> <text>The term of a member is 3 years.</text> </level> <level label="3"> <text>The terms of the members of a board shall be staggered over a 3–year period as required by the terms provided for members of the board in the bylaws filed and approved by the Commissioner on or after June 1, 2003.</text> </level> <level label="4"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="6"> <text>A member may not serve for more than:</text> <level label="i"> <text>three full terms; or</text> </level> <level label="ii"> <text>a total of more than 9 years.</text> </level> </level> <level label="7"> <text>A person may not be a member of the board if the person:</text> <level label="i"> <text>has defaulted on the payment of a monetary obligation to the nonprofit health service plan;</text> </level> <level label="ii"> <text>has been convicted of a criminal offense involving dishonesty or breach of trust or a felony;</text> </level> <level label="iii"> <text>habitually has neglected to pay debts; or</text> </level> <level label="iv"> <text>has been prohibited under any federal securities law from acting as a director or officer of any corporation.</text> </level> </level> <level label="8"> <text>A member shall meet any other qualifications set forth in the bylaws of the nonprofit health service plan.</text> </level> <level label="9"> <text>A member may not be an immediate family member of another board member or an officer or employee of the nonprofit health service plan.</text> </level> <level label="10"> <text>The board shall elect a chairman from among its members.</text> </level> <level label="11"> <level label="i"> <text>The composition of the board shall represent the racial and gender diversity of the State.</text> </level> <level label="ii"> <text>The board shall include representation from each geographic region of the State.</text> </level> </level> </level> <level label="f"> <text>The board shall notify the Commissioner of any member who attends less than 65% of the meetings of the board during a period of 12 consecutive months.</text> </level> <level label="g"> <level label="1"> <text>Board members may receive the following compensation:</text> <level label="i"> <text>reimbursement for ordinary and necessary expenses; and</text> </level> <level label="ii"> <text>an amount of base compensation and compensation for attendance at meetings in accordance with § 14–139 of this subtitle.</text> </level> </level> <level label="2"> <text>A board member may not receive more than the amount specified in paragraph (1) of this subsection for serving on more than one board of a corporation subject to this section.</text> </level> <level label="3"> <level label="i"> <text>This paragraph applies to a corporation that is:</text> <level label="1"> <text>issued a certificate of authority as a nonprofit health service plan; and</text> </level> <level label="2"> <text>the sole member of a corporation issued a certificate of authority as a nonprofit health service plan.</text> </level> </level> <level label="ii"> <text>On or before June 30 of each calendar year, a corporation subject to this paragraph shall report to the Commissioner on:</text> <level label="1"> <text>the total amount of base compensation, compensation for attendance at meetings, and reimbursement for ordinary and necessary expenses paid to each board member in the preceding calendar year; and</text> </level> <level label="2"> <text>the proposed annual compensation, together with necessary supporting documentation, to be paid to board members for the next calendar year.</text> </level> </level> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-115.1" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>In this section, “officer” means any officer that a Maryland corporation is required or permitted to have under § 2-412 of the Corporations and Associations Article.</text> </level> <level label="b"> <level label="1"> <text>An officer of a nonprofit health service plan shall act:</text> <level label="i"> <text>in good faith;</text> </level> <level label="ii"> <text>in a manner that is reasonably believed to be in the best interests of the corporation and its controlled affiliates or subsidiaries that offer health benefit plans;</text> </level> <level label="iii"> <text>in a manner that is consistent with the mission of a nonprofit health service plan as required under § 14-102(c) of this subtitle; and</text> </level> <level label="iv"> <text>with the care that an ordinarily prudent person in a like position would use under similar circumstances.</text> </level> </level> <level label="2"> <text>Except for the receipt of reasonable remuneration in conformity with § 14-139 of this subtitle, an officer of a nonprofit health service plan may not use the position of officer for personal or financial enrichment.</text> </level> <level label="3"> <text>A violation of this subsection shall be considered an unsound or unsafe business practice under § 14-116 of this subtitle.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-116" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>In this section, “unsound or unsafe business practice” means a business practice that:</text> <level label="i"> <text>is detrimental to the financial condition of a nonprofit health service plan and does not conform to sound industry practice;</text> </level> <level label="ii"> <text>impairs the ability of a nonprofit health service plan to pay subscriber benefits; or</text> </level> <level label="iii"> <text>violates § 14-102, § 14-115, § 14-115.1, or § 14-139(a), (b), or (c) of this subtitle.</text> </level> </level> <level label="2"> <text>“Unsound or unsafe business practice” includes:</text> <level label="i"> <text>failing to comply with the notice requirements of § 14-119 of this subtitle;</text> </level> <level label="ii"> <text>willfully hindering an examination of a nonprofit health service plan or its affiliates or subsidiaries; and</text> </level> <level label="iii"> <text>failure of a director to attend at least 65% of the meetings of the board during a period of 12 consecutive months.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>If the Commissioner believes that an officer or director of a nonprofit health service plan has engaged in an unsound or unsafe business practice, the Commissioner shall send a warning to that individual.</text> </level> <level label="2"> <text>If the Commissioner believes that an officer or director of a nonprofit health service plan has failed to take appropriate action in response to a warning received under paragraph (1) of this subsection, the Commissioner may impose a civil penalty not exceeding $125,000 for each warning.</text> </level> <level label="3"> <text>The Commissioner shall send a copy of the warning or, if a civil penalty is imposed under paragraph (2) of this subsection, a copy of the order:</text> <level label="i"> <text>by certified mail, return receipt requested, bearing a postmark from the United States Postal Service, to each director of the nonprofit health service plan; and</text> </level> <level label="ii"> <text>if the nonprofit health service plan is a corporation incorporated in a state other than this State, to the insurance commissioner of the state in which the corporation is incorporated.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>If the nonprofit health service plan is incorporated in this State, the Commissioner may remove the officer or director if the Commissioner determines after a hearing that the unsound or unsafe business practice continued after the warning.</text> </level> <level label="2"> <text>A copy of the removal order shall be served on the individual removed and each director of the nonprofit health service plan.</text> </level> <level label="3"> <text>The individual removed is entitled to a hearing under Title 2 of this article.</text> </level> <level label="4"> <text>Any person aggrieved by a final decision of the Commissioner under this section may appeal the decision under § 2-215 of this article.</text> </level> </level> <level label="d"> <text>A nonprofit health service plan formed or organized under the laws of this State may not:</text> <level label="1"> <text>form or organize under the laws of another jurisdiction unless the Commissioner determines that it is in the public interest; or</text> </level> <level label="2"> <text>alter its structure, operations, or affiliations, if such alteration results in the for-profit activities of the plan becoming so substantial that the Insurance Commissioner determines that the purpose of the nonprofit health service plan may no longer be characterized as operating a nonprofit health service plan.</text> </level> </level> <level label="e"> <text>The Commissioner may revoke a certificate of authority issued to a foreign corporation subject to this subtitle if:</text> <level label="1"> <text>the foreign corporation operates a nonprofit health service plan that is affiliated with a nonprofit health service plan formed or organized under the laws of this State; and</text> </level> <level label="2"> <text>the affiliation between the foreign nonprofit health service plan and the nonprofit health service plan formed or organized under the laws of this State is terminated.</text> </level> </level> <level label="f"> <level label="1"> <text>If the Attorney General has reason to believe that a nonprofit health service plan is engaging in an unsound or unsafe business practice, the Attorney General shall notify the Commissioner.</text> </level> <level label="2"> <text>If the Commissioner fails to take action under this section within 60 days after notification by the Attorney General, the Attorney General may:</text> <level label="i"> <text>investigate the unsound or unsafe business practice; and</text> </level> <level label="ii"> <text>initiate an action in circuit court for appropriate relief to remedy the unsound or unsafe business practice, including the removal of an officer or director of the nonprofit health service plan.</text> </level> </level> <level label="3"> <text>In the course of any investigation conducted by the Attorney General, the Attorney General may:</text> <level label="i"> <text>subpoena witnesses;</text> </level> <level label="ii"> <text>administer oaths;</text> </level> <level label="iii"> <text>examine an individual under oath;</text> </level> <level label="iv"> <text>compel production of records, books, papers, contracts, and other documents; and</text> </level> <level label="v"> <text>obtain all necessary assistance from the Administration.</text> </level> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-117" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <level label="i"> <text>“Assets” means assets that are:</text> <level label="1"> <text>authorized under § 14-120 of this subtitle; and</text> </level> <level label="2"> <text>determined by the Commissioner to be admitted assets under the guidelines issued by the National Association of Insurance Commissioners.</text> </level> </level> <level label="ii"> <text>“Assets” does not include:</text> <level label="1"> <text>cash, notes, or receivables that result from the sale of an asset of a nonprofit health service plan or its affiliate or subsidiary if the purchaser may require the plan to repurchase the asset; or</text> </level> <level label="2"> <text>stock of an affiliate or subsidiary of the plan if the stock has not been issued in accordance with a public offering or is not publicly traded on a recognized stock exchange.</text> </level> </level> <level label="iii"> <text>Notwithstanding subparagraph (ii)2 of this paragraph, “assets” includes stock of an affiliate or subsidiary of a nonprofit health service plan to the extent that the Commissioner determines that the stock has a value that could be made available for the payment of claims and losses.</text> </level> </level> <level label="3"> <text>“Earned premium” means earned premiums under:</text> <level label="i"> <text>insurance contracts and policies; and</text> </level> <level label="ii"> <text>the insured part of other contracts.</text> </level> </level> <level label="4"> <text>“Surplus” means the amount by which assets exceed liabilities described in § 5-103 of this article.</text> </level> </level> <level label="b"> <text>Except as provided in subsection (d) of this section, a corporation authorized under this subtitle shall maintain a surplus in an amount equal to the greater of:</text> <level label="1"> <text>$75,000; and</text> </level> <level label="2"> <text>8% of the total earned premium received by the corporation in the immediately preceding calendar year.</text> </level> </level> <level label="c"> <text>If the size and structure of the corporation requires, the Commissioner may require the differentiation of the corporation’s activities into risk and nonrisk business for the purpose of determining the corporation’s income that is derived from earned premium and other sources.</text> </level> <level label="d"> <text>If the Commissioner determines after a hearing that a larger surplus is necessary for the protection of subscribers to a nonprofit health service plan, the Commissioner may require a corporation authorized under this subtitle to maintain a surplus in an amount greater than the amount required by subsection (b) of this section.</text> </level> <level label="e"> <level label="1"> <text>The surplus of a corporation authorized under this subtitle may be considered to be excessive only if:</text> <level label="i"> <text>the surplus is greater than the appropriate risk based capital requirements as determined by the Commissioner for the immediately preceding calendar year; and</text> </level> <level label="ii"> <text>after a hearing, the Commissioner determines that the surplus is unreasonably large.</text> </level> </level> <level label="2"> <text>After the Commissioner has determined the surplus of a corporation authorized under this subtitle to be excessive, the Commissioner:</text> <level label="i"> <text>may order the corporation to submit a plan for distribution of the excess in a fair and equitable manner; or</text> </level> <level label="ii"> <text>if the corporation fails to submit a plan of distribution within 60 days, may compile a plan and order the corporation to implement it.</text> </level> </level> <level label="3"> <text>A distribution ordered under paragraph (2) of this subsection may be made only to subscribers who are covered by the corporation’s nonprofit health service plan at the time the distribution is made.</text> </level> </level> <level label="f"> <text>The Commissioner may not order a distribution or plan for distribution under subsection (e) of this section if the distribution would render the corporation impaired or insolvent under the laws of its domiciliary state or any other state in which the corporation is authorized to do business.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-118" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>If the minimum surplus of a corporation authorized under this subtitle required to be maintained by § 14-117 of this subtitle becomes impaired, the Commissioner immediately may determine the amount of deficiency and serve notice on the corporation and its board of directors to cure the deficiency within the time period specified by the Commissioner, which may not exceed 120 days after service of the notice.</text> </level> <level label="b"> <text>The corporation may cure the deficiency in cash or in assets eligible for the investment of the corporation’s funds under § 14-120 of this subtitle.</text> </level> <level label="c"> <text>Except as provided in subsection (d) of this section, if a corporation that has been notified of a deficiency under subsection (a) of this section does not cure the deficiency and file proof that it has done so with the Commissioner within the time period specified by the Commissioner:</text> <level label="1"> <text>the corporation may be considered insolvent; and</text> </level> <level label="2"> <text>the Commissioner may institute delinquency proceedings against the corporation under Title 9, Subtitle 2 of this article.</text> </level> </level> <level label="d"> <level label="1"> <text>The corporation may apply for a single extension of not more than 60 days to cure a deficiency.</text> </level> <level label="2"> <text>The Commissioner may grant the extension if:</text> <level label="i"> <text>the corporation shows good cause why the deficiency was not cured in the initial time period specified by the Commissioner; and</text> </level> <level label="ii"> <text>the deficiency exists because the Commissioner required an increased surplus, disallowed certain assets, or reduced the value of certain assets carried in the corporation’s accounts.</text> </level> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-119" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>In addition to the requirements of § 9-231 of this article, if a chief executive officer, chief financial officer, treasurer, or director knows that a nonprofit health service plan or its affiliate or subsidiary is impaired, that individual immediately shall notify the Commissioner of the impairment, unless the Commissioner has already been notified of the impairment by the chief executive officer, chief financial officer, treasurer, or director.</text> </level> <level label="b"> <text>The provisions of § 9-231(d), (f), and (g) of this article apply to notice provided to the Commissioner under this section.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-120" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>In this section, “group health care” means a practice by which an affiliate or subsidiary of a nonprofit health service plan engages the services of health care specialists who provide health care at predetermined locations in accordance with a prepaid health plan.</text> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, a corporation subject to this subtitle may invest its funds only in assets allowed for the investment of the funds of life insurers under §§ 5-101 and 5-102 and Title 5, Subtitle 5 of this article.</text> </level> <level label="2"> <text>If the Commissioner determines that a corporation subject to this subtitle is engaged principally in the business of group health care rather than the sale of an insurance product or plan described in § 14-102 of this subtitle, the Commissioner may allow the corporation to invest a sum not to exceed 50% of its assets in real estate for use as medical facilities and fixed medical equipment to be used solely for the purpose of engaging in group health care.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-121" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>On or before March 1 of each year, unless the Commissioner extends the time for good cause, each nonprofit health service plan shall file with the Commissioner a complete statement of its financial condition, transactions, and affairs for the immediately preceding calendar year.</text> </level> <level label="2"> <text>The annual statement shall:</text> <level label="i"> <text>be in the form and have the content approved for current use by the National Association of Insurance Commissioners or its successor organization; and</text> </level> <level label="ii"> <text>contain any additional information that the Commissioner requires.</text> </level> </level> <level label="3"> <text>The applicable fee required by § 2–112 of this article shall be submitted at the same time as the statement.</text> </level> <level label="4"> <text>Unless the Commissioner extends the time for filing, a nonprofit health service plan that fails to file an annual statement on or before March 10 shall pay a penalty of:</text> <level label="i"> <text>$100 for each day from March 1 to March 10, both inclusive; and</text> </level> <level label="ii"> <text>$150 for each day from March 11 to the day before the Commissioner receives the statement, both inclusive.</text> </level> </level> </level> <level label="b"> <text>At any time, the Commissioner may require a nonprofit health service plan doing business in the State to file an interim statement containing the information that the Commissioner considers necessary.</text> </level> <level label="c"> <level label="1"> <level label="i"> <text>Except as provided in paragraph (2) of this subsection, on or before June 1 of each year, a nonprofit health service plan shall file with the Commissioner an audited financial report for the immediately preceding calendar year.</text> </level> <level label="ii"> <text>The nonprofit health service plan shall have the audited financial report prepared by an independent certified public accountant.</text> </level> <level label="iii"> <text>The Commissioner may:</text> <level label="1"> <text>set requirements for the form and content of the audited financial report; and</text> </level> <level label="2"> <text>for good cause, extend the time for filing the audited financial report.</text> </level> </level> </level> <level label="2"> <text>With 90 days’ advance notice, the Commissioner may require a nonprofit health service plan to file an audited financial report earlier than the date specified in paragraph (1) of this subsection.</text> </level> <level label="3"> <level label="i"> <text>This paragraph does not apply to:</text> <level label="1"> <text>a health maintenance organization required to file an annual report under § 19–717 of the Health – General Article; or</text> </level> <level label="2"> <text>an authorized insurer required to file an annual report under § 4–116 of this article.</text> </level> </level> <level label="ii"> <text>On or before June 1 of each year, a nonprofit health service plan shall file with the Commissioner an audited financial report for each affiliate and subsidiary owned by or under the control of the nonprofit health service plan during the immediately preceding calendar year.</text> </level> <level label="iii"> <text>The Commissioner may, for good cause, extend the time for filing the audited financial reports.</text> </level> <level label="iv"> <text>The audited financial reports:</text> <level label="1"> <text>shall contain the information required by the Commissioner; and</text> </level> <level label="2"> <text>be certified by an independent certified public accountant as to the financial condition, transactions, and affairs of each affiliate and subsidiary for the immediately preceding calendar year.</text> </level> </level> </level> </level> <level label="d"> <text>As part of the audited financial reports required under subsection (c)(3) of this section, each nonprofit health service plan shall:</text> <level label="1"> <text>file a consolidated financial statement that:</text> <level label="i"> <text>covers the nonprofit health service plan and each of its affiliates and subsidiaries; and</text> </level> <level label="ii"> <text>consists of the financial statements of the nonprofit health service plan and each of its affiliates and subsidiaries, certified by an independent certified public accountant as to the financial condition, transactions, and affairs of the plan and its affiliates and subsidiaries for the immediately preceding calendar year;</text> </level> </level> <level label="2"> <text>provide a list of:</text> <level label="i"> <text>the names and addresses of and biographical information about the members of the board of directors of the nonprofit health service plan;</text> </level> <level label="ii"> <text>the total compensation, including all cash and deferred compensation in addition to salary, of:</text> <level label="1"> <text>each member of the board of directors of the nonprofit health service plan;</text> </level> <level label="2"> <text>each officer of the nonprofit health service plan or any affiliate or subsidiary of the plan; and</text> </level> <level label="3"> <text>any employee of the nonprofit health service plan or any affiliate or subsidiary of the plan designated by the Commissioner; and</text> </level> </level> </level> <level label="3"> <text>provide any other information or documents necessary for the Commissioner to ensure compliance with this subtitle.</text> </level> </level> <level label="e"> <text>Unless the Commissioner extends the time for filing, a nonprofit health service plan that fails to file an audited financial report on or before June 10 shall pay a penalty of:</text> <level label="1"> <text>$100 for each day from June 1 to June 10, both inclusive; and</text> </level> <level label="2"> <text>$150 for each day from June 11 to the day before the Commissioner receives the report, both inclusive.</text> </level> </level> <level label="f"> <text>The statements and reports required under this section shall be in the form required by the Commissioner.</text> </level> <level label="g"> <text>Whenever a corporation authorized under this subtitle makes a change that would result in a change in any of the information required under subsection (d) of this section, the corporation shall notify the Commissioner within 30 days after the change becomes effective.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-124" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>The Commissioner may conduct any investigation or hearing that the Commissioner considers necessary to enforce this subtitle.</text> </level> <level label="2"> <text>In conducting a hearing or investigation under this section, the Commissioner has the same powers with respect to nonprofit health service plans as are granted to the Commissioner under Titles 2 and 4 of this article with respect to any other activity regulated under this article.</text> </level> <level label="3"> <text>If another state enacts a law or takes a regulatory action that requires a nonprofit health service plan operating in this State to provide a program or benefits for the residents of the other state or to distribute or reduce its surplus on the grounds that the surplus is excessive in whole or in part, the Commissioner may hold a quasi–legislative hearing or a hearing under Title 2 of this article or conduct an examination to review and evaluate the impact of the law or regulatory action on the nonprofit health service plan, including the impact on:</text> <level label="i"> <text>surplus;</text> </level> <level label="ii"> <text>premium rates for policies issued or delivered in this State; and</text> </level> <level label="iii"> <text>solvency.</text> </level> </level> <level label="4"> <text>Based on the review and evaluation under paragraph (3) of this subsection, the Commissioner shall determine whether the impact on the nonprofit health service plan is harmful to the interests of subscribers covered by policies issued or delivered in this State.</text> </level> <level label="5"> <level label="i"> <text>If the Commissioner determines the program or benefits for the residents of another state or the surplus distribution or reduction have an impact on the nonprofit health service plan that is harmful to the interests of subscribers covered by policies issued or delivered in this State, the Commissioner shall issue an appropriate order to protect the subscribers.</text> </level> <level label="ii"> <text>The order issued under subparagraph (i) of this paragraph may include:</text> <level label="1"> <text>a prohibition on the nonprofit health service plan subsidizing the program or benefits for the residents of another state through:</text> </level> <level label="A"> <text>premiums charged to subscribers under policies issued or delivered in this State; or</text> </level> <level label="B"> <text>use of any surplus earned through policies issued or delivered in this State;</text> </level> <level label="2"> <text>a prohibition on the nonprofit health service plan distributing or reducing its surplus for the benefit of residents of another state; or</text> </level> <level label="3"> <text>any other action the Commissioner considers necessary to protect the interests of the subscribers covered by policies issued or delivered in this State.</text> </level> </level> </level> <level label="6"> <text>A nonprofit health service plan may not distribute or reduce its surplus under a law or regulatory action the impact of which is subject to a hearing or an examination under paragraph (3) of this subsection, except with the approval of the Commissioner.</text> </level> </level> <level label="b"> <text>The Commissioner may adopt regulations to carry out this subtitle.</text> </level> <level label="c"> <text>The Commissioner may commence a delinquency proceeding against a corporation operating under this subtitle for any of the reasons set forth in § 9–211(a) and (b) of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-125" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>The Commissioner or an examiner of the Administration may inspect and examine the affairs of a corporation authorized under this subtitle and an affiliate or subsidiary of a corporation authorized under this subtitle.</text> </level> <level label="b"> <text>In conducting an inspection or examination under this section, the Commissioner or examiner:</text> <level label="1"> <text>shall have free access to all of the books and documents of the corporation and its affiliates or subsidiaries; and</text> </level> <level label="2"> <text>may subpoena and examine under oath any person, including an officer, agent, or employee of the corporation or its affiliates and subsidiaries, in relation to the affairs, transactions, and condition of the corporation or its affiliates and subsidiaries.</text> </level> </level> <level label="c"> <text>The Commissioner may delegate the authority provided under this section to a designee of the Commissioner.</text> </level> <level label="d"> <text>The corporation or its affiliate or subsidiary whose affairs are examined under this section shall pay the expenses of examination in accordance with § 2-208 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-126" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>A corporation subject to this subtitle may not amend its certificate of incorporation, bylaws, or the terms and provisions of contracts issued or proposed to be issued to subscribers to the plan until the proposed amendments have been submitted to and approved by the Commissioner and the applicable fees required by § 2–112 of this article have been paid.</text> </level> <level label="2"> <level label="i"> <text>A corporation subject to this subtitle may not change the table of rates charged or proposed to be charged to subscribers for a form of contract issued or to be issued for health care services until the proposed change has been submitted to and approved by the Commissioner.</text> </level> <level label="ii"> <level label="1"> <text>A nonprofit health service plan that offers a health benefit plan, as defined in § 11–601 of this article, is subject to Title 11, Subtitle 6 of this article for the health benefit plan.</text> </level> <level label="2"> <text>If the provisions of Title 11, Subtitle 6 of this article conflict with the provisions of this section, the provisions of Title 11, Subtitle 6 of this article shall prevail.</text> </level> </level> </level> <level label="3"> <text>The Commissioner shall approve an amendment to the articles of incorporation or bylaws under paragraph (1) of this subsection unless the Commissioner determines the amendment is contrary to the public interest.</text> </level> </level> <level label="b"> <level label="1"> <level label="i"> <text>An amendment may not take effect until 60 days after it is filed with the Commissioner.</text> </level> <level label="ii"> <text>The Commissioner may extend the initial waiting period described in subparagraph (i) of this paragraph for up to an additional 30 days if the Commissioner gives to a corporation subject to this subtitle notice of the extension before the initial waiting period ends.</text> </level> <level label="iii"> <text>If an amendment is not accompanied by the information needed to support it and the Commissioner does not have sufficient information to determine whether the filing meets the requirements of this section, the Commissioner shall require the nonprofit health service plan to provide the needed information.</text> </level> <level label="iv"> <text>If the Commissioner requires additional information, the waiting period under this paragraph shall begin again on the date the needed information is provided.</text> </level> <level label="v"> <text>On written application by the nonprofit health service plan, the Commissioner may authorize an amendment that the Commissioner has reviewed to become effective before the expiration of the waiting period or any extension of the waiting period or at a later date.</text> </level> </level> <level label="2"> <text>A filing is deemed approved unless disapproved by the Commissioner within the waiting period or any extension of the waiting period.</text> </level> <level label="3"> <level label="i"> <text>The Commissioner shall disapprove or modify the proposed change if:</text> <level label="1"> <text>the table of rates appears by statistical analysis and reasonable assumptions to be inadequate, unfairly discriminatory, or excessive in relation to benefits; or</text> </level> <level label="2"> <text>the form contains provisions that are unjust, unfair, inequitable, inadequate, misleading, or deceptive or encourage misrepresentations of the coverage.</text> </level> </level> <level label="ii"> <text>In determining whether to disapprove or modify the form or table of rates, the Commissioner shall consider, to the extent appropriate:</text> <level label="1"> <text>past and prospective loss experience within and outside the State;</text> </level> <level label="2"> <text>underwriting practice and judgment;</text> </level> <level label="3"> <text>a reasonable margin for reserve needs;</text> </level> <level label="4"> <text>past and prospective expenses, both countrywide and those specifically applicable to the State; and</text> </level> <level label="5"> <text>any other relevant factors within and outside the State.</text> </level> </level> </level> <level label="4"> <text>On the adoption of an amendment or change, after approval by the Commissioner, the corporation shall file with the Commissioner a copy of the amendment or change that has been certified by at least two executive officers of the corporation.</text> </level> </level> <level label="c"> <text>At any time, the Commissioner may require a nonprofit health service plan in the State to demonstrate that its filings, including the terms and provisions of its contracts, its table of rates, and its method for setting rates, comply with subsections (a) and (b) of this section, notwithstanding that the Commissioner had previously approved the filings.</text> </level> <level label="d"> <level label="1"> <text>If, after the applicable review period established under subsection (b) of this section, the Commissioner finds that a filing does not meet the requirements of this section, the Commissioner shall issue to the filer an order that specifies the ways in which the filing fails to meet the requirements of this section and states when, within a reasonable period after the order, the filing will no longer be effective.</text> </level> <level label="2"> <level label="i"> <text>The Commissioner shall hold a hearing before issuing an order under paragraph (1) of this subsection.</text> </level> <level label="ii"> <text>The Commissioner shall give written notice of the hearing to the filer at least 10 days before the hearing.</text> </level> <level label="iii"> <text>The written notice shall specify the matters to be considered at the hearing.</text> </level> </level> <level label="3"> <text>An order issued under paragraph (1) of this subsection does not:</text> <level label="i"> <text>affect a contract or policy made or issued before the expiration of the period set forth in the order; or</text> </level> <level label="ii"> <text>directly affect an existing contract or policy between a nonprofit health service plan and a subscriber established in accordance with a collective bargaining agreement.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>The Commissioner may adopt regulations to allow a type or kind of form to be effective upon receipt of the filing by the Commissioner.</text> </level> <level label="2"> <text>If a nonprofit health service plan uses a form which becomes effective in accordance with the provisions of subparagraph (i) of this paragraph and the form would be subject to disapproval under subsection (b)(3) of this section, the Commissioner may:</text> <level label="i"> <text>subsequently disapprove the form; and</text> </level> <level label="ii"> <text>impose on the nonprofit service plan a penalty under § 4–113 of this article.</text> </level> </level> <level label="3"> <text>If a nonprofit health service plan files a form with the Commissioner which becomes effective in accordance with paragraph (1) of this subsection, the nonprofit health service plan shall pay the applicable filing fee provided in § 2–112 of this article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-127" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>Each decision or finding of the Commissioner about rates and forms made under § 14-126 of this subtitle is subject to judicial review in accordance with Title 11, Subtitle 5 of this article.</text> </level> <level label="b"> <text>All other decisions and findings of the Commissioner about a corporation subject to this subtitle are subject to judicial review in accordance with § 2-215 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-130" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>In Part V of this subtitle, “health insurer” means an insurer authorized to write health insurance.</text> </section> <section article="gin" article_name="Insurance" number="14-133" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Affiliate” means a person that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with a corporation subject to this subtitle.</text> </level> <level label="3"> <text>“Control” has the meaning stated in § 7–101(c) of this article.</text> </level> <level label="4"> <text>“Subsidiary” has the meaning stated in § 7–101(g) of this article.</text> </level> </level> <level label="b"> <text>A nonprofit health service plan may not invest in or otherwise acquire an affiliate or subsidiary unless:</text> <level label="1"> <text>the affiliate or subsidiary is licensed by the Commissioner; or</text> </level> <level label="2"> <level label="i"> <text>the affiliate or subsidiary is majority owned by the nonprofit health service plan; and</text> </level> <level label="ii"> <text>the business of the affiliate or subsidiary is directly related to the operation of the nonprofit health service plan or the administration of a health benefits program.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A nonprofit health service plan shall submit a statement of proposed action to the Commissioner before the plan may:</text> <level label="i"> <text>create, acquire, or invest in an affiliate or subsidiary in order to control the affiliate or subsidiary;</text> </level> <level label="ii"> <text>alter the structure, organization, purpose, or ownership of the plan or an affiliate or subsidiary of the corporation;</text> </level> <level label="iii"> <text>make an investment exceeding $500,000; or</text> </level> <level label="iv"> <text>make an investment in an affiliate or subsidiary.</text> </level> </level> <level label="2"> <text>The nonprofit health service plan shall file the statement of proposed action required under this subsection at least 60 days before the effective date of the proposed action.</text> </level> <level label="3"> <text>The nonprofit health service plan may not engage in a proposed action described under paragraph (1)(i) through (iii) of this subsection unless the Commissioner approves the action in writing.</text> </level> <level label="4"> <text>The Commissioner shall either approve or disapprove the proposed action within 60 days after the Commissioner receives the statement of proposed action.</text> </level> <level label="5"> <text>The Commissioner shall approve a statement of proposed action under this section unless the Commissioner determines the proposed action is contrary to the public interest.</text> </level> </level> <level label="d"> <text>The Commissioner may authorize a corporation to comply with the law of its domiciliary jurisdiction if the corporation is domiciled in a jurisdiction that has adopted by statute or regulation provisions that limit the ownership and operation of an affiliate or subsidiary in substantially the same manner as provided in this section.</text> </level> <level label="e"> <level label="1"> <text>If an affiliate or subsidiary of a corporation regulated under this subtitle does not comply with this section, the Commissioner shall require the corporation to file a plan of divestiture or liquidation of the affiliate or subsidiary.</text> </level> <level label="2"> <text>The plan of divestiture or liquidation:</text> <level label="i"> <text>shall state the reasons for noncompliance clearly;</text> </level> <level label="ii"> <text>shall provide the Commissioner with the information that the Commissioner considers necessary to approve the divestiture or liquidation; and</text> </level> <level label="iii"> <text>is proprietary and confidential commercial information under § 4–335 of the General Provisions Article.</text> </level> </level> <level label="3"> <text>Before a divestiture or liquidation under this section, the plan of divestiture or liquidation must be approved by the Commissioner.</text> </level> <level label="4"> <text>Any action by the Commissioner under this section may be appealed in accordance with Title 2 of this article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-136" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>Nonprofit health service plans are subject to Title 27 of this article.</text> </level> <level label="b"> <text>A corporation authorized under this subtitle that maintains or operates a nonprofit health service plan may not:</text> <level label="1"> <text>deny a claim made under a contract, certificate, or policy of a nonprofit health service plan for an unfair or unfairly discriminatory reason;</text> </level> <level label="2"> <text>without just cause, require a person making a claim under a contract, certificate, or policy of a nonprofit health service plan to accept less than the amount due; or</text> </level> <level label="3"> <text>fail to notify in writing a subscriber or certificate holder of a nonprofit health service plan of a denial of a properly completed claim within 60 days after the plan receives the claim.</text> </level> </level> <level label="c"> <text>If it appears to the Commissioner that an act or practice or proposed act or practice of a corporation authorized under this subtitle that maintains or operates a nonprofit health service plan is in violation of subsection (b) of this section or Title 27 of this article, the burden of persuasion is on the corporation to show that the act or practice or proposed act or practice is not in violation of subsection (b) of this section or Title 27 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-137" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <text>A nonprofit health service plan may not issue, renew, or deliver an individual or group contract in the State that excludes coverage for hospital or medical expenses based on a violation of:</text> <level label="1"> <text>a provision of Title 21 of the Transportation Article; or</text> </level> <level label="2"> <text>a provision of the Natural Resources Article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-138" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>Except as provided in subsection (b), (c), or (d) of this section, a nonprofit health service plan or Blue Cross or Blue Shield plan may not disclose specific medical information contained in a subscriber’s or certificate holder’s medical or claims records.</text> </level> <level label="b"> <text>A nonprofit health service plan or Blue Cross or Blue Shield plan may disclose specific medical information or medical data contained in a subscriber’s or certificate holder’s medical or claims records:</text> <level label="1"> <text>to the individual or individual’s agent or representative; or</text> </level> <level label="2"> <text>if the individual authorizes the disclosure.</text> </level> </level> <level label="c"> <text>A nonprofit health service plan or Blue Cross or Blue Shield plan may disclose specific medical information contained in a subscriber’s or certificate holder’s medical records without the authorization of the subscriber or certificate holder:</text> <level label="1"> <text>to a medical review committee, accreditation board, or commission, if the information is requested by or is in furtherance of the purpose of the committee, board, or commission;</text> </level> <level label="2"> <text>in response to legal process;</text> </level> <level label="3"> <text>to another nonprofit health service plan, Blue Cross or Blue Shield plan, or insurer to coordinate benefit payments under multiple sickness and accident, dental, or hospital medical contracts;</text> </level> <level label="4"> <text>to a government agency performing its lawful duties as authorized by an act of the General Assembly or United States Congress;</text> </level> <level label="5"> <text>to a researcher, on request, for medical and health care research in accordance with a protocol approved by an institutional review board;</text> </level> <level label="6"> <text>in accordance with a cost containment contractual obligation to verify that benefits paid by the nonprofit health service plan were proper contractually;</text> </level> <level label="7"> <text>to a third party payor if:</text> <level label="i"> <text>the third party payor does not further disclose the specific medical or claims information; and</text> </level> <level label="ii"> <text>the information is required for an audit of the billing made by the plan to the payor;</text> </level> </level> <level label="8"> <text>to evaluate and adjust a claim for benefits under a policy or to evaluate and calculate provider fiscal incentives or other types of provider payments; or</text> </level> <level label="9"> <text>to the individual’s treating providers for the sole purposes of enhancing or coordinating patient care or assisting the treating providers’ clinical decision making, provided that:</text> <level label="i"> <text>a disclosure under this item is subject to the additional limitations in § 4–307 of the Health – General Article on disclosure of a medical record developed primarily in connection with the provision of mental health services;</text> </level> <level label="ii"> <text>medical information or medical data contained in an insured’s medical or claims records may be disclosed only in accordance with the federal Health Insurance Portability and Accountability Act of 1996, any regulations adopted under the Act, and any other applicable federal privacy laws, and disclosures under this item may not be made in violation of the prohibited uses or disclosures under the federal Health Insurance Portability and Accountability Act of 1996;</text> </level> <level label="iii"> <text>a nonprofit health service plan or Blue Cross or Blue Shield plan that discloses medical information or medical data contained in an insured’s medical or claims records in accordance with this item shall provide a notice consistent with the requirements of 45 C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and the specific types of uses and disclosures that the nonprofit health service plan or Blue Cross or Blue Shield plan may make in accordance with this item;</text> </level> <level label="iv"> <text>the notice required by item (iii) of this item shall include an opportunity for the individual to opt–out of the sharing of the individual’s medical information or medical data contained in an individual’s medical or claims records with the individual’s treating providers for the purposes identified in this item; and</text> </level> <level label="v"> <text>if a nonprofit health service plan or Blue Cross or Blue Shield plan discloses medical information or medical data through an infrastructure that provides organizational and technical capabilities for the exchange of protected health information, as defined in § 4–301 of the Health – General Article, among entities not under common ownership, the nonprofit health service plan or Blue Cross or Blue Shield plan is subject to the requirements of §§ 4–302.2 and 4–302.3 of the Health – General Article.</text> </level> </level> </level> <level label="d"> <text>This section does not prohibit the use of medical records, data, or statistics if the use does not disclose the identity of a particular subscriber or certificate holder.</text> </level> <level label="e"> <text>A nonprofit health service plan that knowingly violates this section is liable to a plaintiff for any damages recoverable in a civil action, including reasonable attorney’s fees.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-139" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <text>An officer, director, or employee of a corporation operating under this subtitle may not:</text> <level label="1"> <text>willfully violate a provision of this article or a regulation adopted under this article;</text> </level> <level label="2"> <text>willfully misrepresent or conceal a material fact in a statement, report, record, or communication provided to the Commissioner;</text> </level> <level label="3"> <text>willfully misrepresent or conceal a material fact to the board of directors;</text> </level> <level label="4"> <text>misappropriate or fail to account properly for money that belongs to the corporation, an insurer, insurance producer, subscriber, or certificate holder;</text> </level> <level label="5"> <text>engage in fraudulent or dishonest practices in connection with the provision or administration of a health service plan;</text> </level> <level label="6"> <text>willfully fail to produce records or allow an examination under § 14-125 of this subtitle; or</text> </level> <level label="7"> <text>willfully fail to comply with a lawful order of the Commissioner.</text> </level> </level> <level label="b"> <text>An officer, director, or trustee of a corporation operating under this subtitle may not receive any immediate or future remuneration as the result of an acquisition or proposed acquisition, as defined under § 6.5-101 of the State Government Article, except in the form of compensation paid for continued employment with the company or acquiring entity.</text> </level> <level label="c"> <text>A director, trustee, officer, executive, or employee of a corporation operating under this subtitle may only approve or receive from the assets of the corporation fair and reasonable compensation in the form of salary, bonuses, or perquisites for work actually performed for the benefit of the corporation.</text> </level> <level label="d"> <level label="1"> <text>The compensation committee of the board shall:</text> <level label="i"> <text>identify nonprofit health service plans in the United States that are similar in size and scope to the nonprofit health service plan managed by the board; and</text> </level> <level label="ii"> <text>develop proposed guidelines, for approval by the board:</text> <level label="1"> <text>for compensation, including salary, bonuses, and perquisites, of all officers and executives that is reasonable in comparison to compensation for officers and executives of similar nonprofit health service plans; and</text> </level> <level label="2"> <text>for compensation for board members that is reasonable in comparison to compensation for board members of similar nonprofit health service plans.</text> </level> </level> </level> <level label="2"> <text>The board shall review the proposed guidelines at least annually.</text> </level> <level label="3"> <text>The board shall:</text> <level label="i"> <text>provide a copy of the approved guidelines:</text> <level label="1"> <text>to each officer and executive of the nonprofit health service plan;</text> </level> <level label="2"> <text>to each candidate for an officer or executive position with the nonprofit health service plan;</text> </level> <level label="3"> <text>to each board member of the nonprofit health service plan; and</text> </level> <level label="4"> <text>on or before September 1, 2004, and annually thereafter, to the Commissioner; and</text> </level> </level> <level label="ii"> <text>adhere to the approved guidelines in compensating the officers, executives, and board members of the nonprofit health service plan.</text> </level> </level> <level label="4"> <text>On an annual basis, the Commissioner shall review:</text> <level label="i"> <text>the compensation paid by the nonprofit health service plan to each officer and executive; and</text> </level> <level label="ii"> <text>the base compensation and compensation for attendance at meetings paid by the nonprofit health service plan to board members.</text> </level> </level> <level label="5"> <text>If the Commissioner finds that the compensation exceeds the amount authorized under the approved guidelines, the Commissioner shall issue an order prohibiting payment of the excess amount.</text> </level> </level> <level label="e"> <text>The approval or receipt of remuneration in violation of an order issued under subsection (d)(5) of this section is a violation of § 14-115(c) of this subtitle and shall be considered an unsound or unsafe business practice under § 14-116 of this subtitle.</text> </level> <level label="f"> <level label="1"> <text>Except for an employee under subsection (c) of this section, a person that violates subsection (a) or (c) of this section is subject to a civil penalty not exceeding $10,000 for each violation.</text> </level> <level label="2"> <text>Instead of or in addition to imposing a civil penalty, the Commissioner may require the violator to make restitution to any person that has suffered financial injury as a result of the violation.</text> </level> </level> <level label="g"> <text>In determining the amount of financial penalty to be imposed, the Commissioner shall consider:</text> <level label="1"> <text>the seriousness of the violation;</text> </level> <level label="2"> <text>the good faith of the violator;</text> </level> <level label="3"> <text>the violator’s history of previous violations;</text> </level> <level label="4"> <text>the deleterious effect of the violation on the public and the nonprofit health service industry; and</text> </level> <level label="5"> <text>the assets of the violator.</text> </level> </level> <level label="h"> <level label="1"> <text>Before assessing a civil penalty or restitution, the Commissioner shall serve by certified mail, return receipt requested, on the person to be charged a notice that contains:</text> <level label="i"> <text>the specifications of the charge; and</text> </level> <level label="ii"> <text>the time and place of a hearing to be held on the charges.</text> </level> </level> <level label="2"> <text>The Commissioner shall hold a hearing on the charges at least 20 days after the date of mailing the notice.</text> </level> <level label="3"> <text>The Commissioner or designee of the Commissioner shall conduct a hearing on the charges in accordance with Title 2, Subtitle 2 of this article.</text> </level> <level label="4"> <text>Subject to Title 2, Subtitle 2 of this article, an appeal may be taken from a final order of the Commissioner to the Circuit Court for Baltimore City.</text> </level> </level> <level label="i"> <text>In addition to any other penalty or remedy under this section, a person that is found to have gained financially from a violation of a provision of this article or a regulation adopted by the Commissioner shall forfeit the gain.</text> </level> <level label="j"> <text>This section does not prevent a person damaged by a director, officer, manager, employee, or agent of a corporation subject to this subtitle from bringing a separate action in a court of competent jurisdiction.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-140" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="1" subtitle_name="Nonprofit Health Service Plans"> <level label="a"> <level label="1"> <text>A person may not engage in the business of operating a nonprofit health service plan unless the person has a certificate of authority issued by the Commissioner under this subtitle.</text> </level> <level label="2"> <text>A person that violates this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $50,000 for each violation.</text> </level> </level> <level label="b"> <level label="1"> <text>A person may not:</text> <level label="i"> <text>violate a provision of this subtitle; or</text> </level> <level label="ii"> <text>make a willfully false statement in a written document required by this subtitle to be filed with the Commissioner.</text> </level> </level> <level label="2"> <text>A person that violates this subsection is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 for each violation or imprisonment not exceeding 1 year or both.</text> </level> </level> <level label="c"> <text>A person that willfully makes a false statement while under an oath administered by the Commissioner or designee of the Commissioner at an investigation or hearing conducted by the Commissioner or designee of the Commissioner is guilty of perjury.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-201" future_version_removed="true" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Allowed amount” means the dollar amount that an insurer determines is the value of the health care service provided by a provider before any cost sharing amounts are applied.</text> </level> <level label="c"> <text>“Assignment of benefits” means the transfer of health care coverage reimbursement benefits or other rights under a preferred provider insurance policy by an insured.</text> </level> <level label="d"> <text>“Balance bill” means the difference between a nonpreferred provider’s bill for a health care service and the insurer’s allowed amount.</text> </level> <level label="e"> <text>“Cost sharing amounts” means the amounts that an insured is responsible for under a preferred provider insurance policy, including any deductibles, coinsurance, or copayments.</text> </level> <level label="f"> <text>“Covered service” means a health care service that is a covered benefit under a preferred provider insurance policy.</text> </level> <level label="g"> <text>“Health care services” has the meaning stated in § 19–701 of the Health – General Article.</text> </level> <level label="h"> <text>“Hospital–based physician” means:</text> <level label="1"> <text>a physician licensed in the State who is under contract to provide health care services to patients at a hospital; or</text> </level> <level label="2"> <text>a group physician practice that includes physicians licensed in the State that is under contract to provide health care services to patients at a hospital.</text> </level> </level> <level label="i"> <text>“Insured” means a person covered for benefits under a preferred provider insurance policy offered or administered by an insurer.</text> </level> <level label="j"> <text>“Medicare economic index” means the fixed–weight input price index that:</text> <level label="1"> <text>measures the weighted average annual price change for various inputs needed to produce physician services; and</text> </level> <level label="2"> <text>is used by the Centers for Medicare and Medicaid Services in the calculation of reimbursement of physician services under Title XVIII of the federal Social Security Act.</text> </level> </level> <level label="k"> <text>“Nonpreferred provider” means a provider that is eligible for payment under a preferred provider insurance policy, but that is not a preferred provider under the applicable provider service contract.</text> </level> <level label="l"> <text>“On–call physician” means a physician who:</text> <level label="1"> <text>has privileges at a hospital;</text> </level> <level label="2"> <text>is required to respond within an agreed upon time period to provide health care services for unassigned patients at the request of a hospital or a hospital emergency department; and</text> </level> <level label="3"> <text>is not a hospital–based physician.</text> </level> </level> <level label="m"> <text>“Preferential basis” means an arrangement under which the insured or subscriber under a preferred provider insurance policy is entitled to receive health care services from preferred providers at no cost, at a reduced fee, or under more favorable terms than if the insured or subscriber received similar services from a nonpreferred provider.</text> </level> <level label="n"> <text>“Preferred provider” means a provider that has entered into a provider service contract.</text> </level> <level label="o"> <text>“Preferred provider insurance policy” means:</text> <level label="1"> <text>a policy or insurance contract that is issued or delivered in the State by an insurer, under which health care services are to be provided to the insured by a preferred provider on a preferential basis; or</text> </level> <level label="2"> <text>another contract that is offered by an employer, third party administrator, or other entity, under which health care services are to be provided to the subscriber by a preferred provider on a preferential basis.</text> </level> </level> <level label="p"> <text>“Provider” means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services.</text> </level> <level label="q"> <text>“Provider service contract” means a contract between a provider and an insurer, employer, third party administrator, or other entity, under which the provider agrees to provide health care services on a preferential basis under specific preferred provider insurance policies.</text> </level> <level label="r"> <text>“Similarly licensed provider” means:</text> <level label="1"> <text>for a physician:</text> <level label="i"> <text>a physician who is board certified or eligible in the same practice specialty; or</text> </level> <level label="ii"> <text>a group physician practice that contains board certified or eligible physicians in the same practice specialty; or</text> </level> </level> <level label="2"> <text>for a health care provider who is not a physician, a health care provider who holds the same type of license or certification.</text> </level> </level> <level label="s"> <text>“Subscriber” means a person covered for benefits under a preferred provider insurance policy issued by a person that is not an insurer.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-202" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <level label="1"> <text>This subtitle applies to insurers that issue or deliver individual or group health insurance policies in the State.</text> </level> <level label="2"> <text>The provisions of this subtitle that apply to insurers also apply to nonprofit health service plans that issue or deliver individual or group health insurance policies in the State.</text> </level> </level> <level label="b"> <text>Except as otherwise provided in § 14-206 of this subtitle, this subtitle does not apply to an employee benefit plan to the extent that the plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA).</text> </level> </section> <section article="gin" article_name="Insurance" number="14-203" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <text>The Commissioner may adopt regulations to enforce this subtitle.</text> </section> <section article="gin" article_name="Insurance" number="14-204" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <text>Subject to the approval of the Commissioner, an insurer may:</text> <level label="1"> <text>offer or administer a health benefit program under which the insurer offers preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers; and</text> </level> <level label="2"> <text>establish terms and conditions that providers must meet to qualify for payment as preferred providers.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-205" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>If a preferred provider insurance policy offered by an insurer provides benefits for a service that is within the lawful scope of practice of a health care provider licensed under the Health Occupations Article, an insured covered by the preferred provider insurance policy is entitled to receive the benefits for that service either through direct payments to the health care provider or through reimbursement to the insured.</text> </level> <level label="b"> <level label="1"> <text>A preferred provider insurance policy offered by an insurer under this subtitle shall provide for payment of services rendered by nonpreferred providers as provided in this subsection.</text> </level> <level label="2"> <text>Unless the insurer demonstrates to the satisfaction of the Commissioner that an alternative level of payment is more appropriate, for each covered service under a preferred provider insurance policy, the difference between the coinsurance percentage applicable to nonpreferred providers and the coinsurance percentage applicable to preferred providers may not be greater than 20 percentage points.</text> </level> <level label="3"> <text>If the preferred provider insurance policy contains a provision for the insured to pay the balance bill, the provision may not apply to an on–call physician or a hospital–based physician who has accepted an assignment of benefits in accordance with § 14–205.2 of this subtitle.</text> </level> <level label="4"> <text>The insurer’s allowed amount for a health care service covered under the preferred provider insurance policy provided by nonpreferred providers may not be less than the allowed amount paid to a similarly licensed provider who is a preferred provider for the same health care service in the same geographic region.</text> </level> </level> <level label="c"> <level label="1"> <text>In this subsection, “unfair discrimination” means an act, method of competition, or practice engaged in by an insurer:</text> <level label="i"> <text>that is prohibited by Title 27, Subtitle 2 of this article; or</text> </level> <level label="ii"> <text>that, although not specified in Title 27, Subtitle 2 of this article, the Commissioner believes is unfair or deceptive and that results in the institution of an action by the Commissioner under § 27–104 of this article.</text> </level> </level> <level label="2"> <text>If the rates for each institutional provider under a preferred provider insurance policy offered by an insurer vary based on individual negotiations, geographic differences, or market conditions and are approved by the Health Services Cost Review Commission, the rates do not constitute unfair discrimination under this article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-205.1" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit health service plan does not restrict payment for covered services provided by nonpreferred providers:</text> <level label="1"> <text>for emergency services, as defined in § 19–701 of the Health – General Article;</text> </level> <level label="2"> <text>for an unforeseen illness, injury, or condition requiring immediate care; or</text> </level> <level label="3"> <text>as required under § 15–830 of this article.</text> </level> </level> <level label="b"> <level label="1"> <text>If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through preferred providers, then the insurer or nonprofit health service plan with which the employer, association, or other private group arrangement is contracting for the coverage shall offer an option to include preferred and nonpreferred providers as an additional benefit for an employee or individual, at the employee’s or individual’s option, to accept or reject.</text> </level> <level label="2"> <text>The insurer or nonprofit health service plan shall provide to each employer, association, or other private group arrangement a disclosure statement on the group application that an option to include preferred and nonpreferred providers is available for the individual or employee to accept or reject.</text> </level> </level> <level label="c"> <text>An employer, association, or other private group arrangement may require an employee or individual that accepts the additional coverage for preferred and nonpreferred providers to pay a premium greater than the amount of the premium for the coverage offered for preferred providers only.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-205.2" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>Except as otherwise provided, this section applies to both on–call physicians and hospital–based physicians who:</text> <level label="1"> <text>are nonpreferred providers;</text> </level> <level label="2"> <text>obtain an assignment of benefits from an insured; and</text> </level> <level label="3"> <text>notify the insurer of an insured in a manner specified by the Commissioner that the on–call physician or hospital–based physician has obtained and accepted the assignment of benefits from the insured.</text> </level> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (3) of this subsection, an insured may not be liable to an on–call physician or a hospital–based physician subject to this section for covered services rendered by the on–call physician or hospital–based physician.</text> </level> <level label="2"> <text>An on–call physician or hospital–based physician subject to this section or a representative of an on–call physician or hospital–based physician subject to this section may not:</text> <level label="i"> <text>collect or attempt to collect from an insured of an insurer any money owed to the on–call physician or hospital–based physician by the insurer for covered services rendered to the insured by the on–call physician or hospital–based physician; or</text> </level> <level label="ii"> <text>maintain any action against an insured of an insurer to collect or attempt to collect any money owed to the on–call physician or hospital–based physician by the insurer for covered services rendered to the insured by the on–call physician or hospital–based physician.</text> </level> </level> <level label="3"> <text>An on–call physician or hospital–based physician subject to this section or a representative of an on–call physician or hospital–based physician subject to this section may collect or attempt to collect from an insured of an insurer:</text> <level label="i"> <text>any deductible, copayment, or coinsurance amount owed by the insured for covered services rendered to the insured by the on–call physician or hospital–based physician;</text> </level> <level label="ii"> <text>if Medicare is the primary insurer and the insurer is the secondary insurer, any amount up to the Medicare approved or limiting amount, as specified under the federal Social Security Act, that is not owed to the on–call physician or hospital–based physician by Medicare or the insurer after coordination of benefits has been completed, for Medicare covered services rendered to the insured by the on–call physician or hospital–based physician; and</text> </level> <level label="iii"> <text>any payment or charges for services that are not covered services.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>This subsection applies only to on–call physicians subject to this section.</text> </level> <level label="2"> <text>For a covered service rendered to an insured of an insurer by an on–call physician subject to this section, the insurer or its agent:</text> <level label="i"> <text>shall pay the on–call physician within 30 days after the receipt of a claim in accordance with the applicable provisions of this title; and</text> </level> <level label="ii"> <text>shall pay a claim submitted by the on–call physician for a covered service rendered to an insured in a hospital, no less than the greater of:</text> <level label="1"> <text>140% of the average rate the insurer paid for the 12–month period that ends on January 1 of the previous calendar year in the same geographic area, as defined by the Centers for Medicare and Medicaid Services, for the same covered service, to similarly licensed providers under written contract with the insurer; or</text> </level> <level label="2"> <text>the average rate the insurer paid for the 12–month period that ended on January 1, 2010, in the same geographic area, as defined by the Centers for Medicare and Medicaid Services, for the same covered service to a similarly licensed provider not under written contract with the insurer, inflated by the change in the Medicare Economic Index from 2010 to the current year.</text> </level> </level> </level> </level> <level label="d"> <level label="1"> <text>This subsection applies only to hospital–based physicians subject to this section.</text> </level> <level label="2"> <text>For a covered service rendered to an insured of an insurer by a hospital–based physician subject to this section, the insurer or its agent:</text> <level label="i"> <text>shall pay the hospital–based physician within 30 days after the receipt of the claim in accordance with the applicable provisions of this title; and</text> </level> <level label="ii"> <text>shall pay a claim submitted by the hospital–based physician for a covered service rendered to an insured no less than the greater of:</text> <level label="1"> <text>140% of the average rate the insurer paid for the 12–month period that ends on January 1 of the previous calendar year in the same geographic area, as defined by the Centers for Medicare and Medicaid Services, for the same covered service, to similarly licensed providers, who are hospital–based physicians, under written contract with the insurer; or</text> </level> <level label="2"> <text>the final allowed amount of the insurer for the same covered service for the 12–month period that ended on January 1, 2010, inflated by the change in the Medicare Economic Index to the current year, to the hospital–based physician billing under the same federal tax identification number the hospital–based physician used in calendar year 2009.</text> </level> </level> </level> </level> <level label="e"> <level label="1"> <text>For the purposes of subsections (c)(2)(ii)1 and (d)(2)(ii)1 of this section, an insurer shall calculate the average rate paid to similarly licensed providers under written contract with the insurer for the same covered service by summing the contracted rate for all occurrences of the Current Procedural Terminology Code for that covered service and then dividing by the total number of occurrences of the Current Procedural Terminology Code.</text> </level> <level label="2"> <text>For the purposes of subsection (c)(2)(ii)2 of this section, an insurer shall calculate the average rate paid to similarly licensed providers not under written contract with the insurer for the same covered service by summing the rates paid to similarly licensed providers not under written contract with the insurer for all occurrences of the Current Procedural Terminology Code for that covered service and then dividing by the total number of occurrences of the Current Procedural Terminology Code.</text> </level> </level> <level label="f"> <text>An insurer shall disclose, on request of an on–call physician or hospital–based physician subject to this section, the reimbursement rate required under subsection (c)(2)(ii) or (d)(2)(ii) of this section.</text> </level> <level label="g"> <level label="1"> <text>An insurer may seek reimbursement from an insured for any payment under subsection (c)(2)(ii) or (d)(2)(ii) of this section for a claim or portion of a claim submitted by an on–call physician or hospital–based physician subject to this section and paid by the insurer that the insurer determines is the responsibility of the insured based on the insurance contract.</text> </level> <level label="2"> <text>The insurer may request and the on–call physician or hospital–based physician shall provide adjunct claims documentation to assist in making the determination under paragraph (1) of this subsection or under subsection (c) of this section.</text> </level> </level> <level label="h"> <level label="1"> <text>An on–call physician or hospital–based physician subject to this section may enforce the provisions of this section by filing a complaint against an insurer with the Administration or by filing a civil action in a court of competent jurisdiction under § 1–501 or § 4–201 of the Courts Article.</text> </level> <level label="2"> <text>The Administration or a court shall award reasonable attorney’s fees if the Administration or court finds that:</text> <level label="i"> <text>the insurer’s conduct in maintaining or defending the proceeding was in bad faith; or</text> </level> <level label="ii"> <text>the insurer acted willfully in the absence of a bona fide dispute.</text> </level> </level> </level> <level label="i"> <text>The Administration may take any action authorized under this article, including conducting an examination under Title 2, Subtitle 2 of this article, to investigate and enforce a violation of the provisions of this section.</text> </level> <level label="j"> <text>In addition to any other penalties under this article, the Commissioner may impose a penalty not to exceed $5,000 on an insurer for each violation of this section.</text> </level> <level label="k"> <text>The Administration, in consultation with the Maryland Health Care Commission, shall adopt regulations to implement this section.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-205.3" future_version_removed="true" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>This section does not apply to on–call physicians or hospital–based physicians.</text> </level> <level label="b"> <text>An insurer may not:</text> <level label="1"> <text>prohibit the assignment of benefits to a provider who is a physician by an insured; or</text> </level> <level label="2"> <text>refuse to directly reimburse a nonpreferred provider who is a physician under an assignment of benefits.</text> </level> </level> <level label="c"> <text>If an insured has not provided an assignment of benefits, the insurer shall include the following information with the payment to the insured for health care services rendered by the nonpreferred provider who is a physician:</text> <level label="1"> <text>the specific claim covered by the payment;</text> </level> <level label="2"> <text>the amount paid for the claim;</text> </level> <level label="3"> <text>the amount that is the insured’s responsibility; and</text> </level> <level label="4"> <text>a statement instructing the insured to use the payment to pay the nonpreferred provider in the event the insured has not paid the nonpreferred provider in full for the health care services rendered by the nonpreferred provider.</text> </level> </level> <level label="d"> <text>If a physician who is a nonpreferred provider seeks an assignment of benefits from an insured, the physician shall provide the following information to the insured, prior to performing a health care service:</text> <level label="1"> <text>a statement informing the insured that the physician is a nonpreferred provider;</text> </level> <level label="2"> <text>a statement informing the insured that the physician may charge the insured for noncovered services;</text> </level> <level label="3"> <text>a statement informing the insured that the physician may charge the insured the balance bill for covered services;</text> </level> <level label="4"> <text>an estimate of the cost of services that the physician will provide to the insured;</text> </level> <level label="5"> <text>any terms of payment that may apply; and</text> </level> <level label="6"> <text>whether interest will apply and, if so, the amount of interest charged by the physician.</text> </level> </level> <level label="e"> <text>A physician who is a nonpreferred provider shall submit the disclosure form developed by the Commissioner under subsection (f) of this section to document to the insurer the assignment of benefits by an insured.</text> </level> <level label="f"> <text>The Commissioner shall develop disclosure forms to implement the requirements under subsections (c) and (d) of this section.</text> </level> <level label="g"> <text>Notwithstanding the provisions of subsection (b) of this section, an insurer may refuse to directly reimburse a nonpreferred provider under an assignment of benefits if:</text> <level label="1"> <text>the insurer receives notice of the assignment of benefits after the time the insurer has paid the benefits to the insured;</text> </level> <level label="2"> <text>the insurer, due to an inadvertent administrative error, has previously paid the insured;</text> </level> <level label="3"> <text>the insured withdraws the assignment of benefits before the insurer has paid the benefits to the nonpreferred provider; or</text> </level> <level label="4"> <text>the insured paid the nonpreferred provider the full amount due at the time of service.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-206" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="2" subtitle_name="Preferred Provider Organizations"> <level label="a"> <text>This section applies to an employee benefit plan whose benefit provisions are governed by the Employee Retirement Income Security Act of 1974 (ERISA) or another federal law.</text> </level> <level label="b"> <text>On request of the Commissioner, each insurer, employer, third party administrator, or other entity that issues, delivers, administers, or offers a preferred provider insurance policy in the State shall file with the Commissioner:</text> <level label="1"> <text>a written summary description and a prototype copy of:</text> <level label="i"> <text>the preferred provider insurance policy;</text> </level> <level label="ii"> <text>all attendant provider service contracts;</text> </level> <level label="iii"> <text>any other related contracts; and</text> </level> <level label="iv"> <text>any amendments to the documents listed in items (i) through (iii) of this item; and</text> </level> </level> <level label="2"> <text>any other related documents or information that the Commissioner requires.</text> </level> </level> <level label="c"> <text>The Commissioner may impose a penalty not exceeding $1,000 for each failure to comply with this section.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-401" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Dental plan” means a contractual arrangement for dental services.</text> </level> <level label="c"> <text>“Dental plan organization” means a person that provides directly, arranges for, or administers a dental plan on a prepaid or postpaid individual or group capitation basis.</text> </level> <level label="d"> <text>“Dental service” means a service included in practicing dentistry as defined in § 4-101 of the Health Occupations Article.</text> </level> <level label="e"> <text>“Enrollee” means an individual or dependent of the individual who is enrolled in a dental plan.</text> </level> <level label="f"> <text>“Evidence of coverage” means a contract or certificate that is issued to an enrollee and that specifies the dental services to which the enrollee is entitled.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-402" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>This subtitle does not apply to:</text> <level label="1"> <text>a dentist or professional dental corporation that accepts payment on a fee-for-service basis for providing specific dental services to individual patients for whom the services have been prediagnosed;</text> </level> <level label="2"> <text>an authorized insurer whose activities are authorized and regulated under other provisions of this article;</text> </level> <level label="3"> <text>a nonprofit health service plan that is subject to Subtitle 1 of this title;</text> </level> <level label="4"> <text>a health maintenance organization that is authorized by and subject to Title 19, Subtitle 7 of the Health - General Article; or</text> </level> <level label="5"> <text>a dental plan whose regulation by the State is preempted by federal law.</text> </level> </level> <level label="b"> <text>In addition to the provisions of this subtitle, dental plan organizations are subject to the provisions of Title 2, Subtitle 5 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-403" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <text>A person may not establish, operate, or administer a dental plan organization or sell, offer to sell, solicit offers to purchase, or receive advance or periodic consideration in conjunction with a dental plan, unless the person has a certificate of authority issued by the Commissioner under this subtitle.</text> </section> <section article="gin" article_name="Insurance" number="14-404" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>Except as provided in subsection (d) of this section, in accordance with this section, a dental plan organization shall have and maintain at all times a surplus equal to the greater of:</text> <level label="1"> <text>$50,000; or</text> </level> <level label="2"> <text>2% of the organizations’ annual gross premium income, up to a maximum of the required capital and surplus of a stock insurer under § 4-103 of this article.</text> </level> </level> <level label="b"> <level label="1"> <text>Except as provided in subsection (d) of this section, a dental plan organization shall deposit with the Commissioner or with any organization or trustee acceptable to the Commissioner through which a custodial or controlled account is used, cash, securities, or any combination of these or other measures that is acceptable to the Commissioner in an amount equal to $25,000 plus 25% of the surplus required in subsection (a) of this section, provided that the deposit shall not be required to exceed $100,000.</text> </level> <level label="2"> <text>The deposit shall be:</text> <level label="i"> <text>an admitted asset of the dental plan organization in the determination of surplus;</text> </level> <level label="ii"> <text>used to protect the interests of the dental plan organization’s enrollees;</text> </level> <level label="iii"> <text>used to assure continuation of limited health care services to enrollees of a dental plan organization that is in rehabilitation or conservation; and</text> </level> <level label="iv"> <text>if a dental plan organization is placed in receivership or liquidation, an asset subject to provisions of the Uniform Insurers Liquidation Act.</text> </level> </level> <level label="3"> <text>All income from deposits shall be an asset of the dental plan organization.</text> </level> <level label="4"> <text>A dental plan organization may withdraw a deposit or any part thereof after making a substitute deposit of equal amount and value.</text> </level> <level label="5"> <text>A substitute deposit of any securities is subject to the approval of the Commissioner.</text> </level> </level> <level label="c"> <text>Except as provided in subsection (d) of this section, the Commissioner may reduce or eliminate the deposit requirement if the dental plan organization has made an acceptable deposit with the State or jurisdiction of domicile for the protection of all enrollees, wherever located, and delivers to the Commissioner a certificate to such effect, duly authenticated by the appropriate State official holding the deposit.</text> </level> <level label="d"> <text>Subject to subsection (e) of this section, subsections (a), (b), and (c) of this section do not apply to a dental plan organization, so long as the dental plan organization:</text> <level label="1"> <text>did not have any enrollees as of January 1, 2000;</text> </level> <level label="2"> <text>held a certificate of authority as of January 1, 2000;</text> </level> <level label="3"> <text>maintains a current certificate of authority; and</text> </level> <level label="4"> <text>complies with all applicable laws and regulations, as determined by the Commissioner.</text> </level> </level> <level label="e"> <text>Subsection (d) of this section does not apply to a dental plan organization that has one or more enrollees on or after January 1, 2000.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-405" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>An applicant for a certificate of authority shall:</text> <level label="1"> <text>file with the Commissioner an application, verified by an officer or authorized representative of the dental plan organization, on the form that the Commissioner provides; and</text> </level> <level label="2"> <text>pay to the Commissioner an application fee of $200.</text> </level> </level> <level label="b"> <text>An application for a certificate of authority shall include:</text> <level label="1"> <text>the basic organizational documents of the dental plan organization, including the articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, and shareholder agreement;</text> </level> <level label="2"> <text>all amendments to the organizational documents of the dental plan organization;</text> </level> <level label="3"> <text>the bylaws, rules and regulations, or similar documents that regulate the conduct or internal affairs of the dental plan organization;</text> </level> <level label="4"> <text>the names, addresses, and official positions of the individuals who are responsible for conducting the affairs of the dental plan organization, including:</text> <level label="i"> <text>the members of the board of directors, board of trustees, executive committee, or other governing board or committee;</text> </level> <level label="ii"> <text>for a corporation, the principal officers; and</text> </level> <level label="iii"> <text>for a partnership or association, the partners or members;</text> </level> </level> <level label="5"> <text>each contract made between a dentist and the dental plan organization;</text> </level> <level label="6"> <text>each contract made between a dentist and an individual listed in item (4) of this subsection, a consultant, or a business manager;</text> </level> <level label="7"> <text>a description of the dental plan organization and its dental plan or plans, facilities, and personnel;</text> </level> <level label="8"> <text>the form of evidence of coverage to be issued to enrollees;</text> </level> <level label="9"> <text>the form of each group contract that is issued to employers, unions, trustees, or others;</text> </level> <level label="10"> <text>a financial statement that details the assets, liabilities, and sources of financial support for the dental plan organization or, if the financial affairs are audited by an independent certified public accountant, a copy of the most recent regular certified financial statement, unless the Commissioner determines that additional or more recent financial information is required for the proper administration of this subtitle;</text> </level> <level label="11"> <text>the proposed method of marketing the dental plan, a financial plan with a 3-year projection of the initial operating results, and a statement of the sources of working capital and any other sources of funding;</text> </level> <level label="12"> <text>if a dental plan organization is not domiciled in the State, an executed power of attorney that appoints the Commissioner as attorney for service of process issued against the dental plan organization in the State;</text> </level> <level label="13"> <text>a description of the geographic area to be served by the dental plan organization; and</text> </level> <level label="14"> <text>any other information that the Commissioner requires.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-406" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <text>Within 10 days after a significant modification of information submitted with the application for a certificate of authority, a dental plan organization shall file notice of the modification with the Commissioner.</text> </section> <section article="gin" article_name="Insurance" number="14-407" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>If the Commissioner is satisfied that the individuals who are responsible for conducting the affairs of the dental plan organization are trustworthy and capable of providing, arranging for, or administering the services offered by the dental plan, the Commissioner shall issue a certificate of authority.</text> </level> <level label="b"> <text>If the Commissioner disapproves an application for a certificate of authority, the Commissioner shall notify the dental plan organization in writing of the reasons for disapproval.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-408" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>A certificate of authority expires on the first June 30 after its effective date unless it is renewed as provided in this section.</text> </level> <level label="b"> <text>The Commissioner shall renew the certificate of authority of a dental plan organization if the dental plan organization remains in compliance with this subtitle and pays to the Commissioner a renewal fee of $100.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-409" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>The Commissioner may suspend or revoke a certificate of authority issued to a dental plan organization under this subtitle if the Commissioner finds that:</text> <level label="1"> <text>the dental plan organization is operating in a manner significantly contrary to that described in §§ 14-403, 14-405, 14-407, and 14-408 of this subtitle;</text> </level> <level label="2"> <text>the dental plan organization issues evidence of coverage that does not comply with § 14-410 of this subtitle;</text> </level> <level label="3"> <text>the dental plan organization can no longer be expected to meet its obligations to enrollees;</text> </level> <level label="4"> <text>the agreements of the dental plan organization with dentists are not sufficient to provide the dental services covered by the dental plan;</text> </level> <level label="5"> <text>the dental plan organization, or authorized person acting on its behalf, has advertised or merchandised its services in an untrue or misleading manner;</text> </level> <level label="6"> <text>the conditions or methods of operation of the dental plan organization make continued operation hazardous to enrollees or the public; or</text> </level> <level label="7"> <text>the dental plan organization has failed to comply with this subtitle or any regulations adopted under this subtitle.</text> </level> </level> <level label="b"> <text>If the Commissioner has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, the Commissioner shall notify the dental plan organization of the suspension or revocation in writing and the grounds.</text> </level> <level label="c"> <text>If the Commissioner suspends the certificate of authority, the dental plan organization may not accept additional enrollees or engage in advertising or solicitation during the period of suspension.</text> </level> <level label="d"> <level label="1"> <text>If the Commissioner revokes the certificate of authority, the dental plan organization shall dissolve its structure immediately after the effective date of the order of revocation and may not conduct further business, except as essential to the orderly conclusion of the affairs of the dental plan organization.</text> </level> <level label="2"> <text>By written order, the Commissioner may allow further operation of the dental plan organization if the Commissioner finds that it is in the best interest of enrollees and that enrollees will be afforded the greatest practical opportunity to obtain continuing dental plan coverage.</text> </level> </level> <level label="e"> <text>Instead of or in addition to suspending or revoking a certificate of authority, the Commissioner may:</text> <level label="1"> <text>impose on the holder a penalty of not less than $1,000 but not exceeding $50,000 for each violation of this subtitle; and</text> </level> <level label="2"> <text>require the holder to make restitution to any person who has suffered financial injury because of a violation of this subtitle.</text> </level> </level> <level label="f"> <level label="1"> <text>Notwithstanding subsections (c), (d), and (e) of this section, a dental plan organization that has had its certificate of authority suspended or revoked, has been ordered to pay a penalty or make restitution, or has suffered an adverse decision by the Commissioner is entitled to a hearing under § 2-210 of this article.</text> </level> <level label="2"> <text>Hearings and appeals from orders of the Commissioner are governed by §§ 2-203 and 2-210 through 2-215 of this article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-410" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>Each enrollee shall receive evidence of coverage that indicates specifically the nature and extent of coverage and the total amount or percentage of payment, if any, that the enrollee must pay for dental services.</text> </level> <level label="b"> <level label="1"> <text>Except as provided under paragraph (2) of this subsection, a dental plan organization shall issue evidence of coverage to each enrollee of the dental plan organization.</text> </level> <level label="2"> <text>If an individual enrollee obtains coverage through a policy or through a contract issued by a medical or dental service corporation, the insurer that issued the policy or the medical or dental service corporation shall issue evidence of coverage.</text> </level> </level> <level label="c"> <text>The dental plan organization, insurer, or medical or dental service corporation may not issue or deliver evidence of coverage or an amendment to evidence of coverage until a copy of the form of evidence of coverage or amendment is filed with and approved by the Commissioner.</text> </level> <level label="d"> <text>The evidence of coverage shall contain:</text> <level label="1"> <text>a clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:</text> <level label="i"> <text>the dental services and the insurance or other benefits, if any, to which enrollees are entitled;</text> </level> <level label="ii"> <text>any limitations on the services or kind of benefits to be provided, including any charge, deductible, or copayment feature; and</text> </level> <level label="iii"> <text>where and in what manner information is available about how services may be obtained; and</text> </level> </level> <level label="2"> <text>a clear and understandable description of the dental plan organization’s method for resolving enrollee complaints.</text> </level> </level> <level label="e"> <text>A dental plan organization, insurer, or medical or dental service corporation that makes a change in evidence of coverage or the amount or percentage of payment that the enrollee must pay, shall issue to the enrollee evidence of the change in a separate document.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-410.1" future_version_removed="true" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act" /> <section article="gin" article_name="Insurance" number="14-411" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>The Commissioner may investigate the business and examine the books, accounts, records, and files of each dental plan organization and to do so shall have reasonably free access to those materials and to the offices and places of business of the dental plan organization.</text> </level> <level label="b"> <level label="1"> <text>A dental plan organization shall preserve its books, accounts, and records for at least 5 years.</text> </level> <level label="2"> <text>Preservation by photographic reproduction shall constitute compliance with this subtitle.</text> </level> </level> <level label="c"> <text>At the discretion of the Commissioner, the Secretary of Health and the State Board of Dental Examiners may participate in investigations and examinations described in this section to verify the solvency of a dental plan organization.</text> </level> <level label="d"> <text>In an examination under this section, the person examined shall pay the expense incurred by the Commissioner, Secretary of Health, and State Board of Dental Examiners in accordance with § 2–208 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-412" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <level label="1"> <text>A dental plan organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees about services of the dental plan organization.</text> </level> <level label="2"> <text>The dental plan organization shall maintain records of all written complaints initiated by enrollees.</text> </level> </level> <level label="b"> <level label="1"> <text>The Commissioner may examine the complaint system of a dental plan organization.</text> </level> <level label="2"> <text>If the Commissioner determines that the complaint system is inadequate, the Commissioner may require a revision of the complaint system.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-413" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>On or before March 1 of each year, each dental plan organization shall file with the Commissioner a complete statement of its financial condition, transactions, and affairs for the immediately preceding calendar year.</text> </level> <level label="b"> <text>The annual statement shall:</text> <level label="1"> <text>be in the form and have the content approved for current use by the National Association of Insurance Commissioners or its successor organization; and</text> </level> <level label="2"> <text>contain any additional information that the Commissioner requires.</text> </level> </level> <level label="c"> <text>Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an annual statement on or before March 10 shall pay a penalty of:</text> <level label="1"> <text>$100 for each day from March 1 to March 10, both inclusive; and</text> </level> <level label="2"> <text>$150 for each day from March 11 to the day before the Commissioner receives the report, both inclusive.</text> </level> </level> <level label="d"> <text>At any time, the Commissioner may require a dental plan organization doing business in the State to file an interim statement containing the information that the Commissioner considers necessary.</text> </level> <level label="e"> <level label="1"> <text>Except as provided in paragraph (5) of this subsection, on or before June 1 of each year, each dental plan organization shall file with the Commissioner an audited financial report for the immediately preceding calendar year.</text> </level> <level label="2"> <text>The dental plan organization shall have the audited financial report prepared by an independent certified public accountant.</text> </level> <level label="3"> <text>The Commissioner may:</text> <level label="i"> <text>set requirements for the form and content of the audited financial report; and</text> </level> <level label="ii"> <text>for good cause, extend the time for filing the audited financial report.</text> </level> </level> <level label="4"> <text>Unless the Commissioner extends the time for filing, a dental plan organization that fails to file an audited financial report on or before June 10 shall pay a penalty of:</text> <level label="i"> <text>$100 for each day from June 1 to June 10, both inclusive; and</text> </level> <level label="ii"> <text>$150 for each day from June 11 to the day before the Commissioner receives the report, both inclusive.</text> </level> </level> <level label="5"> <text>With 90 days’ advance notice, the Commissioner may require a dental plan organization to file an audited financial report earlier than the date specified in paragraph (1) of this subsection.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-414" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <text>A dental plan organization may not use more than 50% of its gross contract and certificate income in any fiscal year for general operating expenses, acquisition expenses, and miscellaneous taxes, licenses, and fees.</text> </section> <section article="gin" article_name="Insurance" number="14-415" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>A dental plan organization or its representative may not cause or knowingly allow:</text> <level label="1"> <text>advertising that is untrue or misleading;</text> </level> <level label="2"> <text>solicitation that is untrue or misleading; or</text> </level> <level label="3"> <text>any form of evidence of coverage that is deceptive.</text> </level> </level> <level label="b"> <text>Unless a dental plan organization holds a certificate of authority as an insurer, the dental plan organization may not use in its name, evidence of coverage, or literature:</text> <level label="1"> <text>the words “insurance”, “assurance”, “casualty”, “surety”, or “mutual”; or</text> </level> <level label="2"> <text>any other words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of an insurer authorized to do business in the State.</text> </level> </level> <level label="c"> <text>The Commissioner shall enforce this section.</text> </level> <level label="d"> <text>This subtitle does not limit the powers of the Attorney General and the procedures with respect to consumer fraud.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-416" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>The Commissioner may issue an order that directs a dental plan organization or its representative to cease and desist from engaging in an act or practice that violates this subtitle.</text> </level> <level label="b"> <level label="1"> <text>Within 20 days after service of the cease and desist order, the dental plan organization or its representative may request a hearing to determine whether a violation of this subtitle has occurred.</text> </level> <level label="2"> <text>A hearing under this subsection shall be conducted in accordance with § 2-213 of this article and is subject to judicial review in accordance with § 2-215 of this article.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-417" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>The Commissioner may bring an action in a court of competent jurisdiction of the State to enjoin a dental plan organization from transacting any further business, or from transferring or disposing of its property, if:</text> <level label="1"> <text>the dental plan organization becomes insolvent or suspends its ordinary business for lack of funds; or</text> </level> <level label="2"> <text>the Commissioner finds, as a result of an examination authorized by this subtitle or in any other manner, that:</text> <level label="i"> <text>the dental plan organization is exceeding its powers or is violating the law;</text> </level> <level label="ii"> <text>the condition or methods of business of the dental plan organization may render the continuance of its operations hazardous to enrollees or the public; or</text> </level> <level label="iii"> <text>the assets of the dental plan organization are less than its liabilities.</text> </level> </level> </level> <level label="b"> <text>The court may:</text> <level label="1"> <text>proceed in the action in a summary manner or otherwise;</text> </level> <level label="2"> <text>grant injunctive relief and appoint a receiver, with power to:</text> <level label="i"> <text>sue for, collect, receive, take into possession, sell, convey, and assign all the goods and chattels, rights and credits, money and effects, lands and tenement, books, papers, choses in action, bills, notes, and property of every description belonging to the dental plan organization;</text> </level> <level label="ii"> <text>authorize the purchase of continuing coverage for enrollees utilizing the remaining assets; and</text> </level> <level label="iii"> <text>hold and dispose of any proceeds under the direction of the court; and</text> </level> </level> <level label="3"> <text>cause the receiver to continue the existing operations of the dental plan organization, under court supervision, until the next anniversary of the subscription certificates and contracts then in force.</text> </level> </level> <level label="c"> <text>A dental plan organization is deemed insolvent whenever it is presently or prospectively unable to fulfill its outstanding contracts and maintain the surpluses required under this subtitle.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-418" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act"> <level label="a"> <text>Except for contracts referred to in § 14-405(b)(5) of this subtitle and complaints filed under § 14-412 of this subtitle, applications, filings, and reports required under this subtitle are public documents and may not be considered confidential.</text> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, information obtained by a dental plan organization about the diagnosis, treatment, or health of an enrollee is confidential and may not be disclosed.</text> </level> <level label="2"> <text>A dental plan organization may disclose information described in paragraph (1) of this subsection:</text> <level label="i"> <text>to the extent that disclosure may be necessary to carry out the purposes of this subtitle;</text> </level> <level label="ii"> <text>with the express consent of the enrollee;</text> </level> <level label="iii"> <text>under statute or court order for the production or discovery of evidence; or</text> </level> <level label="iv"> <text>if the information is pertinent to a claim or in litigation between the enrollee and dental plan organization.</text> </level> </level> </level> <level label="c"> <text>A dental plan organization may claim any statutory privileges against disclosure of information that the dentist who provides the information to the dental plan organization may claim.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-601" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <level label="1"> <text>“Discount drug plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other financial consideration paid by or on behalf of a plan member, provides the right to receive discounts on specified pharmaceutical supplies, prescription drugs, or medical equipment and supplies from specified providers.</text> </level> <level label="2"> <text>“Discount drug plan” does not include:</text> <level label="i"> <text>a business arrangement or contract in which the fees, dues, charges, and other financial consideration paid by or on behalf of a plan member consist only of:</text> <level label="1"> <text>a payment made directly to a provider as a dispensing or transactional fee in connection with the purchase of pharmaceutical supplies, prescription drugs, or medical equipment and supplies that are subject to a discount; or</text> </level> <level label="2"> <text>an administrative or processing fee paid by anyone other than a plan member to a provider in connection with that provider’s provision of discounts to plan members; or</text> </level> </level> <level label="ii"> <text>a patient assistance program that:</text> <level label="1"> <text>is sponsored, offered, or provided for by a pharmaceutical manufacturer; and</text> </level> <level label="2"> <text>is not provided in exchange for fees, dues, charges, or other financial consideration.</text> </level> </level> </level> </level> <level label="c"> <text>“Discount drug plan organization” means an entity that:</text> <level label="1"> <text>contracts directly or indirectly with providers or provider networks to provide pharmaceutical supplies, prescription drugs, or medical equipment and supplies at a discount to plan members; and</text> </level> <level label="2"> <text>determines the charge to plan members.</text> </level> </level> <level label="d"> <text>“Discount medical plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other financial consideration paid by or on behalf of a plan member, provides the right to receive discounts on specified medical services from specified providers.</text> </level> <level label="e"> <text>“Discount medical plan organization” means an entity that:</text> <level label="1"> <text>contracts directly or indirectly with providers or provider networks to provide medical services at a discount to plan members; and</text> </level> <level label="2"> <text>determines the charge to plan members.</text> </level> </level> <level label="f"> <text>“Hospital services” has the meaning stated in § 19–201 of the Health – General Article.</text> </level> <level label="g"> <text>“Medical services” means any care, service, or treatment of illness or dysfunction of, or injury to, the human body, including physician care, outpatient services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric care services, and laboratory services.</text> </level> <level label="h"> <text>“Medicare prescription drug plan” means a plan that provides a Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Modernization Act.</text> </level> <level label="i"> <text>“Plan member” means any individual who pays fees, dues, charges, or other financial consideration for the right to receive the benefits of a discount medical plan or a discount drug plan.</text> </level> <level label="j"> <text>“Provider” means:</text> <level label="1"> <text>any person or institution which is contracted, directly or indirectly, with a discount medical plan organization to provide medical services to plan members; or</text> </level> <level label="2"> <text>any person or institution which is contracted, directly or indirectly, with a discount drug plan organization to provide pharmaceutical supplies, prescription drugs, or medical equipment and supplies to plan members.</text> </level> </level> <level label="k"> <text>“State prescription drug plan” means any discount plan operated by a State agency.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-602" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>Except as provided in subsection (b) of this section, this subtitle does not apply to an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization that holds a certificate of authority in this State.</text> </level> <level label="b"> <text>An insurer, nonprofit health service plan, health maintenance organization, or dental plan organization shall:</text> <level label="1"> <text>comply with §§ 14–606 through 14–611 of this subtitle;</text> </level> <level label="2"> <text>notify the Commissioner in writing that it sells, markets, or solicits a discount medical plan or discount drug plan in the State; and</text> </level> <level label="3"> <level label="i"> <text>file annually with the Commissioner a current list of the persons, other than licensed insurance producers, who are authorized to sell, market, or solicit in the State a discount medical plan or discount drug plan established by the insurer, nonprofit health service plan, health maintenance organization, or dental plan organization; and</text> </level> <level label="ii"> <text>provide the Commissioner with an additional list on request.</text> </level> </level> </level> <level label="c"> <text>An insurer, nonprofit health service plan, health maintenance organization, or dental plan organization may file the list required under subsection (b)(3) of this section electronically, in a format prescribed by the Commissioner.</text> </level> <level label="d"> <text>This subtitle does not apply to Medicare prescription drug plans or to a State prescription drug plan.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-603" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <level label="1"> <text>An entity shall register with the Commissioner as a discount medical plan organization before a discount medical plan established by that entity is sold, marketed, or solicited in the State.</text> </level> <level label="2"> <text>A discount medical plan may not be sold, marketed, or solicited in the State unless the discount medical plan organization that established the discount medical plan is registered with the Commissioner.</text> </level> </level> <level label="b"> <level label="1"> <text>An entity shall register with the Commissioner as a discount drug plan organization before a discount drug plan established by that entity is sold, marketed, or solicited in the State.</text> </level> <level label="2"> <text>A discount drug plan may not be sold, marketed, or solicited in the State unless the discount drug plan organization that established the discount drug plan is registered with the Commissioner.</text> </level> </level> <level label="c"> <text>An applicant for registration shall:</text> <level label="1"> <text>file with the Commissioner an application on the form that the Commissioner requires; and</text> </level> <level label="2"> <text>pay to the Commissioner an application fee of $250.</text> </level> </level> <level label="d"> <text>An entity that is required to register with the Commissioner under both subsections (a) and (b) of this section may file one application with the Commissioner and pay one application fee.</text> </level> <level label="e"> <text>An applicant shall file with its application a list of the persons authorized to sell, market, or solicit a discount medical plan or discount drug plan established by the applicant.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-604" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>A registration expires on the second June 30 following the registration unless it is renewed as provided in this section.</text> </level> <level label="b"> <text>Before a registration expires, the registrant may renew it for an additional 2–year term, if the registrant:</text> <level label="1"> <text>otherwise is entitled to be registered;</text> </level> <level label="2"> <text>files with the Commissioner a renewal application on the form that the Commissioner requires; and</text> </level> <level label="3"> <text>pays to the Commissioner a renewal fee of $150.</text> </level> </level> <level label="c"> <text>An application for renewal of a registration shall be considered made in a timely manner if it is postmarked on or before June 30 of the year of renewal.</text> </level> <level label="d"> <text>Subject to the provisions of § 14–605 of this subtitle, the Commissioner shall renew the registration of each registrant that meets the requirements of this section.</text> </level> <level label="e"> <level label="1"> <text>A registrant shall file annually with the Commissioner a current list of the persons authorized to sell, market, or solicit in the State a discount medical plan or discount drug plan established by the registrant.</text> </level> <level label="2"> <text>A registrant shall provide the Commissioner an additional list on request.</text> </level> <level label="3"> <text>A registrant may file the list required under this subsection electronically, in a format prescribed by the Commissioner.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-605" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>Subject to the hearing provisions of Title 2 of this article, the Commissioner may deny a registration to an applicant or refuse to renew, suspend, or revoke the registration of a registrant if the applicant or registrant, or an officer, director, or employee of the applicant or registrant:</text> <level label="1"> <text>makes a material misstatement or misrepresentation in an application for registration;</text> </level> <level label="2"> <text>fraudulently or deceptively obtains or attempts to obtain a registration for the applicant or registrant or for another;</text> </level> <level label="3"> <text>has been convicted of a felony or of a misdemeanor involving moral turpitude;</text> </level> <level label="4"> <text>in connection with the administration of a discount medical plan or discount drug plan, commits fraud or engages in illegal or dishonest activities;</text> </level> <level label="5"> <text>has violated any provision of this subtitle or a regulation adopted under it;</text> </level> <level label="6"> <text>provides a false, falsely disparaging, or misleading oral or written statement, visual description, or other representation of any kind that has the capacity, tendency, or effect of deceiving or misleading consumers;</text> </level> <level label="7"> <text>makes a representation that a discount medical plan or discount drug plan has a sponsorship, approval, characteristic, use, or benefit that it does not have;</text> </level> <level label="8"> <text>has violated § 13–301 of the Commercial Law Article; or</text> </level> <level label="9"> <text>fails to maintain on file with the Commissioner a current list of the persons authorized to sell, market, or solicit a discount medical plan or discount drug plan established by the applicant or the registrant.</text> </level> </level> <level label="b"> <text>This section does not limit any regulatory power of the Commissioner under Title 2 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-606" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <text>A discount medical plan organization and a discount drug plan organization may not:</text> <level label="1"> <text>use in their advertisements, marketing material, brochures, and discount cards the term “insurance” except:</text> <level label="i"> <text>in the name of an insurer, nonprofit health service plan, health maintenance organization, or dental plan organization whose corporate name includes the word “insurance”;</text> </level> <level label="ii"> <text>when comparing the discount medical plan or discount drug plan to insurance or otherwise distinguishing the discount medical plan or discount drug plan from insurance; or</text> </level> <level label="iii"> <text>as otherwise provided in this subtitle;</text> </level> </level> <level label="2"> <text>use in their advertisements, marketing material, brochures, and discount cards the terms “health plan”, “coverage”, “copay”, “copayments”, “preexisting conditions”, “guaranteed issue”, “premium”, “ppo”, “preferred provider organization”, or other terms in a context that could reasonably mislead a person into believing the discount medical plan or discount drug plan was health insurance;</text> </level> <level label="3"> <text>have restrictions on access to discount medical plan or discount drug plan providers, including waiting periods and notification periods;</text> </level> <level label="4"> <text>pay providers any fees for medical services, pharmaceutical supplies, prescription drugs, or medical equipment and supplies, except that a discount medical plan organization or a discount drug plan organization that also has an active registration under Title 8, Subtitle 3 of this article may continue to pay fees to providers in its capacity as a third party administrator;</text> </level> <level label="5"> <text>refuse to modify the method of payment for membership in a discount medical plan or a discount drug plan on request, unless a specific method of payment is required as a term of the discount medical plan or the discount drug plan and was agreed to in writing in advance;</text> </level> <level label="6"> <text>if membership is billed on a monthly basis, refuse to permit membership to terminate without financial penalty on no more than 30 calendar days’ written notice; or</text> </level> <level label="7"> <level label="i"> <text>continue electronic fund transfer as a method of payment more than 30 calendar days after a written request for termination of electronic fund transfer has been made; or</text> </level> <level label="ii"> <text>require the member to notify more than one entity that is either the discount medical plan organization or the discount drug plan organization or an entity identified by the discount medical plan organization or the discount drug plan organization that electronic fund transfer should be terminated.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-607" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>The following disclosures shall be made in writing printed in 12 point type to any prospective member of a discount medical plan organization and shall be included in any marketing materials or brochures relating to an application or contract for a discount medical plan:</text> <level label="1"> <text>a statement that the discount medical plan is not insurance;</text> </level> <level label="2"> <text>a statement that membership in the discount medical plan entitles members to discounts for certain medical services offered by providers who have agreed to participate in the discount medical plan;</text> </level> <level label="3"> <text>a statement that the discount medical plan organization itself does not pay providers of medical services for services provided to plan members;</text> </level> <level label="4"> <text>a statement that the plan member is required to pay for any medical service provided, but is entitled to receive a discount on certain identified medical services from those providers who have contracted with the discount medical plan organization;</text> </level> <level label="5"> <text>a description of the medical services subject to discount, a description of the discounts that the plan member is entitled to receive, and the mechanism by which a current or prospective plan member can obtain the names of the providers that have contracted with the discount medical plan organization to offer discounts to plan members;</text> </level> <level label="6"> <text>the name, location, and contact information, including a telephone number, for the discount medical plan organization;</text> </level> <level label="7"> <text>all fees, dues, charges, or other financial consideration to be paid by the plan member with respect to the member’s participation in the discount medical plan, including all fees or charges relating to the processing of discounts or billing;</text> </level> <level label="8"> <text>if the marketing materials or brochures refer to hospital services, a statement that the discount medical plan does not offer a discount on hospital services in Maryland; and</text> </level> <level label="9"> <text>if applicable, a statement that a nominal fee associated with enrollment costs will be retained by the discount medical plan organization, in accordance with § 14–608(a) of this subtitle, if membership is canceled within the first 30 calendar days after the effective date of enrollment.</text> </level> </level> <level label="b"> <text>The following disclosures shall be made in writing printed in 12 point type to any prospective member of a discount drug plan organization and shall be included in any marketing materials or brochures relating to an application or contract for a discount drug plan:</text> <level label="1"> <text>a statement that the discount drug plan is not:</text> <level label="i"> <text>insurance; or</text> </level> <level label="ii"> <text>a Medicare prescription drug plan;</text> </level> </level> <level label="2"> <text>a statement that membership in the discount drug plan entitles members to discounts for certain pharmaceutical supplies, prescription drugs, or medical equipment and supplies offered by providers who have agreed to participate in the discount drug plan;</text> </level> <level label="3"> <text>a statement that the discount drug plan organization itself does not pay providers of pharmaceutical supplies, prescription drugs, and medical equipment and supplies provided to plan members;</text> </level> <level label="4"> <text>a statement that the discount drug plan member is required to pay for all pharmaceutical supplies, prescription drugs, and medical equipment and supplies provided, but is entitled to receive a discount on certain identified pharmaceutical supplies, prescription drugs, or medical equipment and supplies from those providers who have contracted with the discount drug plan organization;</text> </level> <level label="5"> <text>a description of the discounts that the discount drug plan member is entitled to receive and the mechanism by which a current or prospective plan member can obtain:</text> <level label="i"> <text>unless the discount drug plan offers an open formulary, a listing of the items, including prescription drugs, subject to discount; and</text> </level> <level label="ii"> <text>the names of the providers who have contracted to offer discounts to plan members;</text> </level> </level> <level label="6"> <text>the name, location, and contact information, including a telephone number, for the discount drug plan organization;</text> </level> <level label="7"> <text>all fees, dues, charges, or other financial consideration to be paid by the plan member with respect to the member’s participation in the discount drug plan, including all fees or charges relating to the processing of discounts or billing; and</text> </level> <level label="8"> <text>if applicable, a statement that a nominal fee associated with enrollment costs will be retained by the discount drug plan organization, in accordance with § 14–608(a) of this subtitle, if membership is canceled within the first 30 calendar days after the effective date of enrollment.</text> </level> </level> <level label="c"> <text>If a discount medical plan or a discount drug plan is sold, marketed, or solicited by telephone, the disclosures required by subsections (a) and (b) of this section shall be:</text> <level label="1"> <text>made orally; and</text> </level> <level label="2"> <text>included with the membership card when mailed to the prospective plan member.</text> </level> </level> <level label="d"> <text>The following disclosures shall be made in writing in 12 point type in any advertisement to promote interest in or promote the desire to inquire further about a discount medical plan:</text> <level label="1"> <text>a statement that the discount medical plan is not insurance;</text> </level> <level label="2"> <text>a statement that membership in the discount medical plan entitles members to discounts for certain medical services offered by providers who have agreed to participate in the discount medical plan;</text> </level> <level label="3"> <text>a statement that the plan member, and not the discount medical plan organization, is required to pay for all medical services provided;</text> </level> <level label="4"> <text>the name, location, and contact information, including a telephone number, for the discount medical plan organization;</text> </level> <level label="5"> <text>a statement of the mechanism by which a prospective plan member may obtain the names of the providers who have contracted to offer discounts to plan members; and</text> </level> <level label="6"> <text>if the advertisement refers to hospital services, a statement that the discount medical plan does not offer a discount on hospital services in Maryland.</text> </level> </level> <level label="e"> <text>The following disclosures shall be made in writing in 12 point type in any advertisement to promote interest in or promote the desire to inquire further about a discount drug plan:</text> <level label="1"> <text>a statement that the discount drug plan is not:</text> <level label="i"> <text>insurance; or</text> </level> <level label="ii"> <text>a Medicare prescription drug plan;</text> </level> </level> <level label="2"> <text>a statement that membership in the discount drug plan entitles members to discounts for certain pharmaceutical supplies, prescription drugs, or medical equipment and supplies offered by providers who have agreed to participate in the discount drug plan;</text> </level> <level label="3"> <text>a statement that the plan member, and not the discount drug plan organization, is required to pay for all pharmaceutical supplies, prescription drugs, or medical equipment and supplies provided;</text> </level> <level label="4"> <text>the name, location, and contact information, including a telephone number, for the discount drug plan organization; and</text> </level> <level label="5"> <text>a statement of the mechanism by which a prospective plan member may obtain the names of the providers who have contracted to offer discounts to plan members.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-608" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <level label="1"> <text>If membership in a discount medical plan or a discount drug plan is canceled within the first 30 calendar days after the effective date of enrollment, all fees, dues, charges, or other financial consideration, except a nominal fee, not to exceed any fees, dues, charges, or other financial consideration the member has already paid, associated with enrollment costs that were part of the cost of the discount medical plan card or the discount drug plan card, shall be refunded to the payor on return of the discount medical plan card to the discount medical plan organization or return of the discount drug plan card to the discount drug plan organization.</text> </level> <level label="2"> <text>The Commissioner, in consultation with the Attorney General, shall adopt regulations that establish standards for determining the nominal fee associated with enrollment costs that may be retained by a discount medical plan organization or a discount drug plan organization under this subsection.</text> </level> <level label="3"> <text>Subject to paragraph (1) of this subsection, any regulation adopted under this subsection shall include a cap on the nominal fee that may be retained.</text> </level> </level> <level label="b"> <text>If a discount medical plan organization or a discount drug plan organization cancels a membership for any reason other than nonpayment, the discount medical plan organization or discount drug plan organization shall make a pro rata refund to the payor of all fees, dues, charges, or other financial consideration within 30 calendar days after the date of cancellation.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-609" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>Each discount medical plan organization and each discount drug plan organization shall provide to a plan member or to a plan member for the member’s family a discount card that includes, at a minimum, the following data elements:</text> <level label="1"> <text>a statement that the discount medical plan or discount drug plan is not insurance;</text> </level> <level label="2"> <level label="i"> <text>the name or identifying trademark of the discount medical plan organization or the discount drug plan organization; or</text> </level> <level label="ii"> <text>the name or identifying trademark of the provider networks that participate with the discount medical plan or discount drug plan; and</text> </level> </level> <level label="3"> <text>the telephone number that the plan member may call for assistance.</text> </level> </level> <level label="b"> <level label="1"> <text>If a change occurs in the data element required under subsection (a)(3) of this section, a discount medical plan organization or a discount drug plan organization shall reissue a discount card.</text> </level> <level label="2"> <text>A discount medical plan organization or a discount drug plan organization shall notify a plan member when there is a material change in plan benefits or in the data elements required under subsection (a)(1), (2), or (3) of this section.</text> </level> </level> </section> <section article="gin" article_name="Insurance" number="14-610" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, records, and assets of a discount medical plan organization or discount drug plan organization.</text> </level> <level label="b"> <text>The examination shall be conducted in accordance with § 2–207 of this article.</text> </level> <level label="c"> <text>The expense of the examination shall be paid in accordance with § 2–208 of this article.</text> </level> <level label="d"> <text>The reports of the examination and investigation shall be issued in accordance with § 2–209 of this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-611" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <level label="a"> <text>To enforce this subtitle and any regulation adopted under it, the Commissioner may issue an order:</text> <level label="1"> <text>that requires the violator to cease and desist from the identified violation and further similar violations;</text> </level> <level label="2"> <text>that requires the violator to take specific affirmative action to correct the violation;</text> </level> <level label="3"> <text>that requires the violator to make restitution of money, property, or other assets to a person who has suffered financial injury because of the violation; or</text> </level> <level label="4"> <text>that requires a discount medical plan organization or a discount drug plan organization to make restitution of money, property, or other assets to a person who has suffered financial injury because of a violation by any person authorized to sell, market, solicit, or administer a discount medical plan or discount drug plan established by the discount medical plan organization or discount drug plan organization while the person is acting with the actual or apparent authority of the discount medical plan organization or discount drug plan organization.</text> </level> </level> <level label="b"> <level label="1"> <text>An order of the Commissioner issued under this section may be served on a violator who is registered under this subtitle in the manner provided in Title 2 of this article.</text> </level> <level label="2"> <text>An order of the Commissioner issued under this section may be served on a violator that is not registered under this subtitle in the manner provided for service on an unauthorized insurer that does an act of insurance business in Title 4 of this article.</text> </level> <level label="3"> <text>A request for a hearing on any order issued under this subsection does not stay that portion of the order that requires the violator to cease and desist from conduct identified in the order.</text> </level> <level label="4"> <text>The Commissioner may file a petition in the circuit court of any county to enforce an order issued under this section, whether or not a hearing has been requested or, if requested, whether or not a hearing has been held.</text> </level> <level label="5"> <text>If the Commissioner prevails in an action brought by the Commissioner under this section, the Commissioner may recover for the use of the State reasonable attorney’s fees and the costs of the action.</text> </level> </level> <level label="c"> <level label="1"> <text>In addition to any other enforcement action taken by the Commissioner under this section, the Commissioner may impose a civil penalty of not more than $10,000 for each violation of this subtitle.</text> </level> <level label="2"> <text>Notwithstanding paragraph (1) of this subsection, the Commissioner may impose a civil penalty of not more than $1,000 per day for each day that a person is in violation of § 14–603 of this subtitle.</text> </level> </level> <level label="d"> <text>This section does not limit any regulatory power of the Commissioner under this article.</text> </level> </section> <section article="gin" article_name="Insurance" number="14-612" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="6" subtitle_name="Discount Medical Plan Organizations and Discount Drug Plan Organizations"> <text>The Commissioner shall adopt regulations to carry out the provisions of this subtitle.</text> </section>