{"data":{"id":"us-md/md.-code-insurance-14-201","jurisdiction":"us-md","citation":"Md. Code, Insurance § 14–201","heading":"","body":"(a) In this subtitle the following words have the meanings indicated.\n(b) “Allowed amount” means the dollar amount that an insurer determines is the value of the health care service provided by a provider before any cost sharing amounts are applied.\n(c) “Assignment of benefits” means the transfer of health care coverage reimbursement benefits or other rights under a preferred provider insurance policy by an insured.\n(d) “Balance bill” means the difference between a nonpreferred provider’s bill for a health care service and the insurer’s allowed amount.\n(e) “Cost sharing amounts” means the amounts that an insured is responsible for under a preferred provider insurance policy, including any deductibles, coinsurance, or copayments.\n(f) “Covered service” means a health care service that is a covered benefit under a preferred provider insurance policy.\n(g) “Health care services” has the meaning stated in § 19–701 of the Health – General Article.\n(h) “Hospital–based physician” means:\n(1) a physician licensed in the State who is under contract to provide health care services to patients at a hospital; or\n(2) a group physician practice that includes physicians licensed in the State that is under contract to provide health care services to patients at a hospital.\n(i) “Insured” means a person covered for benefits under a preferred provider insurance policy offered or administered by an insurer.\n(j) “Medicare economic index” means the fixed–weight input price index that:\n(1) measures the weighted average annual price change for various inputs needed to produce physician services; and\n(2) is used by the Centers for Medicare and Medicaid Services in the calculation of reimbursement of physician services under Title XVIII of the federal Social Security Act.\n(k) “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.\n(l) “On–call physician” means a physician who:\n(1) has privileges at a hospital;\n(2) is required to respond within an agreed upon time period to provide health care services for unassigned patients at the request of a hospital or a hospital emergency department; and\n(3) is not a hospital–based physician.\n(m) “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.\n(n) “Preferred provider” means a provider that has entered into a provider service contract.\n(o) “Preferred provider insurance policy” means:\n(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\n(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.\n(p) “Provider” means a physician, hospital, or other person that is licensed or otherwise authorized to provide health care services.\n(q) “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.\n(r) “Similarly licensed provider” means:\n(1) for a physician:\n(i) a physician who is board certified or eligible in the same practice specialty; or\n(ii) a group physician practice that contains board certified or eligible physicians in the same practice specialty; or\n(2) for a health care provider who is not a physician, a health care provider who holds the same type of license or certification.\n(s) “Subscriber” means a person covered for benefits under a preferred provider insurance policy issued by a person that is not an insurer.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=14-201","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"937731ea8daf9b7b75946d50f47e91ae8b9da59a2088b56b27435cefaa2350b4","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-14-140","next":"us-md/md.-code-insurance-14-202"},"notice":"GroundRules: Original legal text. Not legal advice."}