Section 14-201 - Definitions. [Subject to amendment effective July 1, 2011; amended version follows this section]. - Maryland Statutes

§ 14-201. Definitions. [Subject to amendment effective July 1, 2011; amended version follows this section].
 

(a)  In general.- In this subtitle the following words have the meanings indicated. 

(b)  Insured.- "Insured" means a person covered for benefits under a preferred provider insurance policy offered or administered by an insurer. 

(c)  Nonpreferred provider.- "Nonpreferred provider" means a provider that is eligible for payment under a preferred provider insurance policy, but that is not a preferred provider under the applicable provider service contract. 

(d)  Preferential basis.- "Preferential basis" means an arrangement under which the insured or subscriber under a preferred provider insurance policy is entitled to receive health care services from preferred providers at no cost, at a reduced fee, or under more favorable terms than if the insured or subscriber received similar services from a nonpreferred provider. 

(e)  Preferred provider.- "Preferred provider" means a provider that has entered into a provider service contract. 

(f)  Preferred provider insurance policy.- "Preferred provider insurance policy" means: 

(1) a policy or insurance contract that is issued or delivered in the State by an insurer, under which health care services are to be provided to the insured by a preferred provider on a preferential basis; or 

(2) another contract that is offered by an employer, third party administrator, or other entity, under which health care services are to be provided to the subscriber by a preferred provider on a preferential basis. 

(g)  Provider.- "Provider" means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services. 

(h)  Provider service contract.- "Provider service contract" means a contract between a provider and an insurer, employer, third party administrator, or other entity, under which the provider agrees to provide health care services on a preferential basis under specific preferred provider insurance policies. 

(i)  Subscriber.- "Subscriber" means a person covered for benefits under a preferred provider insurance policy issued by a person that is not an insurer. 
 

[An. Code 1957, art. 48A, § 655; 1997, ch. 35, § 2; 2007, ch. 243.]