# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 11 — Health Insurance — Group

### Chapter 06 — Comprehensive Standard Health Benefit Plan

#### Regulation .08 Mandatory Point-of-Service Option or Out-of-Network Option.

*COMAR 31.11.06.08*

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.