# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 41 — Assignment of Benefits to Nonpreferred Providers

#### Regulation .02 Definitions.

*COMAR 31.10.41.02*

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.