# Insurance (GIN)

## Title 15. Health Insurance

### Subtitle 21. Capitated Payments

#### Section 15-2101

(a) In this subtitle the following words have the meanings indicated.

(b) "Administrator" means a carrier administering a self-funded group health plan.

(c) "Carrier" has the meaning stated in Sec. 15-113 of this title.

(d) "Health benefit plan" has the meaning stated in Sec. 2-112.2 of this article.

(e) "Health care practitioner" has the meaning stated in Sec. 15-113 of this title.

(f) "Member" has the meaning stated in Sec. 15-10A-01 of this title.

(g) "Network" has the meaning stated in Sec. 15-112 of this title.

(h) "Participant" means an employee or an employee's dependent who participates in a self-funded group health insurance plan.

(i) "Set of health care practitioners" has the meaning stated in Sec. 15-113 of this title.

#### Section 15-2102

(a) This section applies to arrangements under a health benefit plan offered by a carrier or a self-funded group health insurance plan in which a capitated payment is:

  (1) calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;

  (2) to cover the provision of a set of services defined in the health care practitioner's or set of health care practitioners' contract and rendered by the health care practitioner or set of health care practitioners; and

  (3) paid periodically regardless of utilization of the services by the members or participants.

(b) Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care practitioners is not engaged in insurance business as described in Sec. 4-205 of this article solely because the health care practitioner or set of health care practitioners enters into a contract with a carrier that includes capitated payments for services provided by the health care practitioner or set of health care practitioners.

(c) A health care practitioner or set of health care practitioners is not engaged in insurance business as described in Sec. 4-205(c) of this article solely because the health care practitioner or set of health care practitioners enters into a contract with an administrator that includes capitated payments for services provided by the health care practitioner or set of health care practitioners to members of a self-funded group health plan if:

  (1) the health care practitioner or set of health care practitioners participates in the administrator's network and accepts capitated payments;

  (2) the self-funded group health plan retains the obligation to provide access to covered health care benefits to participants; and

  (3) the contract does not include other reimbursement arrangements that are considered acts of an insurance business under Sec. 4-205(c) of this article.

(d) Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:

  (1) alter any requirement for a carrier or self-funded group health plan to pay a hospital or related institution the rate approved by the Health Services Cost Review Commission for hospital services; or

  (2) supersede the Health Services Cost Review Commission's jurisdiction or authority over rate review and approval for hospital services.

---

Md. Code Ann., Ins. (as displayed at mgaleg.maryland.gov, October 16, 2026)