<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 31.11.06.08" title_num="31" subtitle_num="11" chapter_num="06" heading="Mandatory Point-of-Service Option or Out-of-Network Option.">
  <paragraph num="A.">
    <text>When a health maintenance organization is the sole delivery system offered to employees by an eligible employer, the health maintenance organization:</text>
    <paragraph num="(1)">
      <text>Shall offer the employer a mandatory point-of-service option for the individual employee to accept or reject;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May not impose a minimum participation level on the mandatory point-of-service option;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>May not limit the benefits a covered person can receive out of network;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>As part of the application, shall provide to each eligible employer the following disclosure statement for each point-of-service option offered:</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Shall offer the employer a mandatory dental point-of-service option for the individual employee to accept or reject;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May not impose a minimum participation level on the mandatory dental point-of-service option;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>As part of the application, shall provide to each eligible employer the following disclosure statement for each dental point-of-service option offered:</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Shall offer the employer a mandatory out-of-network option for the individual employee to accept or reject;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May not impose a minimum participation level on the mandatory out-of-network option;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>May not limit the benefits a covered person can receive from non-preferred providers;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>As part of the application, shall provide to each eligible employer the following disclosure statement for each out-of-network option offered:</text>
    </paragraph>
    <aftertext>"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.</aftertext>
  </paragraph>
  <paragraph num="D.">
    <text>This regulation does not apply to self-employed individuals.</text>
  </paragraph>
</regulation>