§ 15–10D-03
Statutes in effect as of October 1, 2026.
Md. Code Ann., Ins. § 15-10D-03 (2026)
Title 15. Health Insurance
Subtitle 10D. Complaint Process for Coverage Decisions
§ 15–10D-03LinkCopy Citation
(a)
It is a violation of this subtitle for a carrier to fail to fulfill the carrier’s obligations to provide or reimburse for health care services specified in the carrier’s policies or contracts with members.
(b)
If, in rendering a coverage decision or appeal decision, a carrier fails to fulfill the carrier’s policies or contracts with members, the Commissioner may:
(1)
issue an administrative order that requires the carrier to:
(i)
cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier;
(ii)
fulfill the carrier’s contractual obligations;
(iii)
provide a health care service or payment that has been denied improperly; or
(iv)
take appropriate steps to restore the carrier’s ability to provide a health care service or payment that is provided under a contract; or
(2)
impose any penalty or fine or take any action as authorized:
(i)
for an insurer, nonprofit health service plan, or dental plan organization, under this article; or
(ii)
for a health maintenance organization, under the Health - General Article or under this article.