Regulation .02 Definitions.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Allowed amount” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(2)
“Assignment of benefits” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(3)
“Carrier” means an insurer or nonprofit health service plan.
(4)
“Covered service” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(5)
“Explanation of benefits” means the document that is provided by a carrier to an insured that explains the claims paid, reduced, or denied by the carrier.
(6)
“Hospital-based physician” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland and does not include an on-call physician.
(7)
“Insured” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(8)
“Insurer” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.
(9)
“Nonpreferred provider” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(10)
“Nonprofit health service plan” means a person who has a certificate of authority to operate as a nonprofit health service plan in Maryland.
(11)
“On-call physician” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(12)
“Preferential basis” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
(13)
“Preferred provider insurance policy” means a policy or insurance contract issued or delivered in the State by a carrier under which health care services furnished by a preferred provider are paid on a preferential basis.