{"data":{"id":"us-md/md.-code-insurance-15-2102","jurisdiction":"us-md","citation":"Md. Code, Insurance § 15–2102","heading":"","body":"(a) This section applies to arrangements under a health benefit plan offered by a carrier or a self–funded group health insurance plan in which a capitated payment is:\n(1) calculated as a fixed amount per member or participant assigned or attributed to the health care practitioner or set of health care practitioners;\n(2) to cover the provision of a set of services defined in the health care practitioner’s or set of health care practitioners’ contract and rendered by the health care practitioner or set of health care practitioners; and\n(3) paid periodically regardless of utilization of the services by the members or participants.\n(b) Subject to the requirements of subsection (c) of this section, a health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205 of this article solely because the health care practitioner or set of health care practitioners enters into a contract with a carrier that includes capitated payments for services provided by the health care practitioner or set of health care practitioners.\n(c) A health care practitioner or set of health care practitioners is not engaged in insurance business as described in § 4–205(c) of this article solely because the health care practitioner or set of health care practitioners enters into a contract with an administrator that includes capitated payments for services provided by the health care practitioner or set of health care practitioners to members of a self–funded group health plan if:\n(1) the health care practitioner or set of health care practitioners participates in the administrator’s network and accepts capitated payments;\n(2) the self–funded group health plan retains the obligation to provide access to covered health care benefits to participants; and\n(3) the contract does not include other reimbursement arrangements that are considered acts of an insurance business under § 4–205(c) of this article.\n(d) Notwithstanding subsections (b) and (c) of this section, nothing in this section may be construed to:\n(1) alter any requirement for a carrier or self–funded group health plan to pay a hospital or related institution the rate approved by the Health Services Cost Review Commission for hospital services; or\n(2) supersede the Health Services Cost Review Commission’s jurisdiction or authority over rate review and approval for hospital services.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=15-2102","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"808c0bf3a09aeb669140d70d6a84f6a44be7b2f5da4023b574d91e1a975ea44a","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-15-2101","next":"us-md/md.-code-insurance-16-101"},"notice":"GroundRules: Original legal text. Not legal advice."}