Regulation .08 Mandatory Point-of-Service Option or Out-of-Network Option.
Regulation .08 Mandatory Point-of-Service Option or Out-of-Network Option.LinkCopy Citation
A.
When a health maintenance organization is the sole delivery system offered to employees by an eligible employer, the health maintenance organization:
(1)
Shall offer the employer a mandatory point-of-service option for the individual employee to accept or reject;
(2)
May not impose a minimum participation level on the mandatory point-of-service option;
(3)
May not limit the benefits a covered person can receive out of network;
(4)
As part of the application, shall provide to each eligible employer the following disclosure statement for each point-of-service option offered:
B.
By July 1, 1996, when a carrier's provider panel is the sole delivery system offered to employees by an eligible employer for dental services, the carrier:
(1)
Shall offer the employer a mandatory dental point-of-service option for the individual employee to accept or reject;
(2)
May not impose a minimum participation level on the mandatory dental point-of-service option;
(3)
As part of the application, shall provide to each eligible employer the following disclosure statement for each dental point-of-service option offered:
C.
When an exclusive provider delivery system is the sole delivery system offered to employees by an eligible employer, the insurer or nonprofit health service plan:
(1)
Shall offer the employer a mandatory out-of-network option for the individual employee to accept or reject;
(2)
May not impose a minimum participation level on the mandatory out-of-network option;
(3)
May not limit the benefits a covered person can receive from non-preferred providers;
(4)
As part of the application, shall provide to each eligible employer the following disclosure statement for each out-of-network option offered:
"Under Maryland law, your employees may purchase an out-of-network option as an additional benefit. An out-of-network option allows your employees to obtain health care services from non-preferred providers under certain circumstances that are described in Attachment A.
D.
This regulation does not apply to self-employed individuals.