<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-10D-03" title_number="15" title_name="Health Insurance" subtitle_number="10D" subtitle_name="Complaint Process for Coverage Decisions">
  <level label="a">
    <text>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.</text>
  </level>
  <level label="b">
    <text>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:</text>
    <level label="1">
      <text>issue an administrative order that requires the carrier to:</text>
      <level label="i">
        <text>cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier;</text>
      </level>
      <level label="ii">
        <text>fulfill the carrier’s contractual obligations;</text>
      </level>
      <level label="iii">
        <text>provide a health care service or payment that has been denied improperly; or</text>
      </level>
      <level label="iv">
        <text>take appropriate steps to restore the carrier’s ability to provide a health care service or payment that is provided under a contract; or</text>
      </level>
    </level>
    <level label="2">
      <text>impose any penalty or fine or take any action as authorized:</text>
      <level label="i">
        <text>for an insurer, nonprofit health service plan, or dental plan organization, under this article; or</text>
      </level>
      <level label="ii">
        <text>for a health maintenance organization, under the Health - General Article or under this article.</text>
      </level>
    </level>
  </level>
</section>
