# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 44 — Network Adequacy

#### Regulation .07 Provider-to-Enrollee Ratio Standards.

*COMAR 31.10.44.07*

A. Except for a Group Model HMOs health benefit plan, the provider panel for each carrier shall meet the provider-to-enrollee ratio standards listed in §B of this regulation.

B. The provider-to-enrollee ratios shall be equivalent to at least 1 full-time physician, or as appropriate, another full-time provider for:

  (1) 1,200 enrollees for primary care;

  (2) 2,000 enrollees for pediatric care;

  (3) 2,000 enrollees for obstetrical/gynecological care;

  (4) 2,000 enrollees for mental health care or services; and

  (5) 2,000 enrollees for substance use disorder care or services.

C. The ratios described in §B of this regulation shall be calculated based on:

  (1) The number of enrollees covered under all health benefit plans issued by the carrier in Maryland that use that provider panel; and

  (2) The number of providers in that provider panel with practicing locations:

    (a) In Maryland; or

    (b) Within the applicable maximum travel distance standard specified in Regulation .05 of this chapter outside the geographic boundaries of Maryland.