<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1011" title_number="15" title_name="Health Insurance" subtitle_number="10" subtitle_name="Claims and Utilization Review">
  <level label="a">
    <level label="1">
      <text>This section applies to:</text>
      <level label="i">
        <text>insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and</text>
      </level>
      <level label="ii">
        <text>health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.</text>
      </level>
    </level>
    <level label="2">
      <text>This section does not apply to claims for reimbursement:</text>
      <level label="i">
        <text>for services received under Medicare supplemental policies or contracts; or</text>
      </level>
      <level label="ii">
        <text>for pharmaceutical or vision services.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>An entity subject to this section shall permit an insured, a subscriber, or a member seeking reimbursement for expenses incurred by the insured, subscriber, or member, in connection with a covered service provided in the United States, to submit a claim for reimbursement:</text>
    <level label="1">
      <text>by first–class mail; and</text>
    </level>
    <level label="2">
      <text>at the election of the entity:</text>
      <level label="i">
        <text>by facsimile transmission; or</text>
      </level>
      <level label="ii">
        <text>through a Web site that allows for the secure transmission of information.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>An entity subject to this section annually shall provide:</text>
    <level label="1">
      <text>a notice that a claims form may be submitted:</text>
      <level label="i">
        <text>by first–class mail; and</text>
      </level>
      <level label="ii">
        <text>at the election of the entity:</text>
        <level label="1">
          <text>by facsimile transmission; or</text>
        </level>
        <level label="2">
          <text>through a Web site that allows for the secure transmission of information; and</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>instructions on how to submit a claim by facsimile transmission or through a secure Web site.</text>
    </level>
  </level>
</section>
