<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 31.11.06.09" title_num="31" subtitle_num="11" chapter_num="06" heading="Mandated Benefits.">
  <paragraph num="A.">
    <text>The plan excludes mandated benefits, except for Insurance Article, §§15-123(d), 15-401, 15-407, 15-408, 15-409, 15-412(a)—(h), 15-414, 15-604, 15-701, 15-811, 15-812, 15-815, 15-816, 15-823, 15-839, and 15-10B-09, Annotated Code of Maryland, and Health-General Article, §§19-703(d) and (g), 19-706(h), 19-710.1(b)(1)(ii), and 19-712.5, Annotated Code of Maryland, to the extent those sections are considered mandated benefits.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Notwithstanding the mandated benefits included in Regulation .09A of this chapter, the requirements of Insurance Article, §15-812(g), Annotated Code of Maryland, relating to imposition of copayment, coinsurance, or deductibles, are inapplicable to a HSA-compatible delivery system.</text>
  </paragraph>
  <paragraph num="C.">
    <text>These regulations do not exclude any requirement contained in statute or regulation that a carrier shall pay hospitals for hospital services rendered in accordance with rates approved by the Health Services Cost Review Commission.</text>
  </paragraph>
  <paragraph num="D.">
    <text>A health maintenance organization shall include the conversion benefit required under COMAR 31.12.02.11.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Referrals to Specialists. Each carrier:</text>
    <paragraph num="(1)">
      <text>That does not allow direct access to specialists shall provide for a standing referral to a specialist under the requirements of Insurance Article, §15-830, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall provide for a referral to a specialist who is not part of the carrier's panel under the requirements of Insurance Article, §15-830, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>[Shall] For plan years beginning before September 23, 2010, shall provide direct access to obstetric and gynecological care as specified in Insurance Article, §15-816, Annotated Code of Maryland; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For plan years beginning on or after September 23, 2010, shall provide direct access to obstetric and gynecological care as specified in 45 CFR 147.138(a)(3).</text>
    </paragraph>
  </paragraph>
</regulation>