About.

In 1998, the Appeals and Grievance Law was enacted by the Maryland General Assembly to provide a full and fair process for resolving disputes regarding the medical necessity of a proposed or delivered health care service, in accordance with Title 15, Subtitle 10A of the Maryland Insurance Article.  As required by the Appeals and Grievance Law, insurance carriers licensed to sell health insurance in this state must provide an accounting of the adverse decisions issued by their company and the disposition of any ensuing grievance filed by the member appealing that decision.  This accounting will be submitted quarterly to the Maryland Insurance Administration on the form entitled "Reporting Form for Maryland Insurance Code §15-10A-06."

A carrier that does not issue any policies that are subject to §15-10A-06 may request an exemption.  Carriers who issue policies providing a "health benefit plan" as defined in §2-112.2(a) of the Insurance Article are required to comply with §15-10A-06.  Generally, the types of policies that are exempt from filing are those that do not provide medical or dental benefits, or, if those benefits are provided, medical or dental necessity is not a requirement of coverage.  A carrier that does not have policies in force in Maryland meeting the definition of health benefit plan may write to Louis S. Butler, Jr, Director, Appeals & Grievance Unit, Maryland Insurance Administration, 200 St. Paul Place, Suite 2700, Baltimore, MD 21202, or email AGCarrier.mia@maryland.gov to request an exemption.