§ 15-1A-13
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/md/insurance/15-1a-13A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1A–13.
(a)If a carrier requires or provides for the designation of a participating primary care provider for an insured individual, the carrier shall allow each insured individual to designate any participating primary care provider if the provider is available to accept the insured individual.
(i)This subsection applies only to an individual who has a child who is an insured individual under the individual’s health benefit plan.
(ii)This subsection may not be construed to waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of pediatric care.
(2)If a carrier requires or provides for the designation of a participating primary care provider for a child, the carrier shall allow the individual to designate any participating physician who specializes in pediatrics as the child’s primary care provider if the provider is available to accept the child.
(i)This subsection applies only to a carrier that:
1. provides coverage for obstetrical or gynecological care; and
2. requires the designation by an insured individual of a participating primary care provider.
(ii)This subsection may not be construed to:
1. waive any exclusions of coverage under the terms and conditions of a health benefit plan with respect to coverage of obstetrical or gynecological care; or
2. prohibit a carrier from requiring that the obstetrical or gynecological provider notify the primary care provider or carrier for an insured individual of treatment decisions.
(2)A carrier shall treat the provision of obstetrical and gynecological care and the ordering of related obstetrical and gynecological items and services by a participating health care provider that specializes in obstetrics or gynecology as care authorized by the primary care provider for the insured individual.
(3)A carrier may not require authorization or referral by any person, including the primary care provider for the insured individual, for an insured individual who seeks coverage for obstetrical or gynecological care provided by a participating health care provider who specializes in obstetrics or gynecology.
(4)A health care provider that provides obstetrical or gynecological care shall comply with a carrier’s policies and procedures.