<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-130" title_number="15" title_name="Health Insurance" subtitle_number="1" subtitle_name="General Provisions">
  <level label="a">
    <level label="1">
      <text>This section applies to:</text>
      <level label="i">
        <text>insurers and nonprofit health service plans that provide coverage for prescription drugs on an outpatient basis under health insurance policies or contracts that are issued or delivered in the State;</text>
      </level>
      <level label="ii">
        <text>health maintenance organizations that provide coverage for prescription drugs on an outpatient basis under contracts that are issued or delivered in the State;</text>
      </level>
      <level label="iii">
        <text>managed care organizations, as defined in § 15–101 of the Health – General Article, that provide coverage for prescription drugs on an outpatient basis under contracts that are issued or delivered in the State; and</text>
      </level>
      <level label="iv">
        <text>to the extent consistent with State and federal law, third party administrators.</text>
      </level>
    </level>
    <level label="2">
      <text>This section does not apply to:</text>
      <level label="i">
        <text>short–term travel or accident–only policies;</text>
      </level>
      <level label="ii">
        <text>short–term nonrenewable policies of not more than 3 months duration; or</text>
      </level>
      <level label="iii">
        <text>any health maintenance organization that operates or maintains its own pharmacies and dispenses, on an annual basis, over 95% of prescription drugs on an outpatient basis to its enrollees at its own pharmacies.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>Each entity subject to this section shall provide to its insureds, subscribers, or enrollees a health insurance benefit card, prescription benefit card, or other technology that:</text>
    <level label="1">
      <level label="i">
        <text>complies with the standards set forth in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect at the time of issuance of the card or other technology; or</text>
      </level>
      <level label="ii">
        <text>includes, at a minimum, the following data elements:</text>
        <level label="1">
          <text>the name or identifying trademark of the entity subject to this section or, if another entity administers the prescription benefit, the name or identifying trademark of the benefit administrator;</text>
        </level>
        <level label="2">
          <text>the name and identification number of the insured, subscriber, or enrollee;</text>
        </level>
        <level label="3">
          <text>the telephone number that providers may call for pharmacy benefit assistance; and</text>
        </level>
        <level label="4">
          <text>all electronic transaction routing information and other numbers required by the entity subject to this section or benefit administrator to process a prescription claim electronically; and</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>indicates which State agency regulates, in whole or in part, the policy or contract offered by the entity by:</text>
      <level label="i">
        <text>for an entity subject to the Administration, displaying “MIA” prominently; or</text>
      </level>
      <level label="ii">
        <text>for an entity subject to the Maryland Department of Health, displaying “MDH” prominently.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>If an entity subject to this section contracts with or otherwise arranges for the prescription benefit to be administered by another subsidiary or entity, including a pharmacy benefit manager, the entity subject to this section shall require the benefit administrator to comply with this section.</text>
  </level>
  <level label="d">
    <level label="1">
      <text>The health insurance benefit card, prescription benefit card, or other technology shall be issued to each insured, subscriber, or enrollee by an entity subject to this section.</text>
    </level>
    <level label="2">
      <text>If a change occurs in any of the data elements required under subsection (b)(1)(ii) of this section, an entity subject to this section shall:</text>
      <level label="i">
        <text>reissue a health insurance benefit card, prescription drug benefit card, or other technology; or</text>
      </level>
      <level label="ii">
        <text>provide the insured, subscriber, or enrollee with the corrective information necessary to electronically process a prescription claim.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <text>An entity subject to this section may comply with this section by issuing to each insured, subscriber, or enrollee a health insurance benefit card that contains data elements related to both prescription and nonprescription health insurance benefits.</text>
  </level>
  <level label="f">
    <text>The Maryland Department of Health shall adopt regulations to enable managed care organizations to comply with:</text>
    <level label="1">
      <text>the requirements of this section; and</text>
    </level>
    <level label="2">
      <text>any unique requirements of the HealthChoice Program that relate to the electronic processing of claims.</text>
    </level>
  </level>
</section>
