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Quarterly Reviews and Inspections of Downstream Risk Providers - mdinsurance state md

Quarterly Reviews and Inspections of Downstream Risk Providers - mdinsurance state md 2025

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The document is a bulletin from the Maryland Insurance Administration outlining the requirements for health maintenance organizations (HMOs) and managed care organizations (MCOs) regarding quarterly reviews and inspections of downstream risk providers. It details the necessary procedures, reporting obligations, and compliance standards mandated by Section 19-713.2 of the Health-General Article, including on-site inspections, financial assessments, and the maintenance of segregated funds to ensure proper payment practices and operational compliance.

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What does the Maryland insurance administration do?

Overview of Our Responsibilities License insurance companies and producers operating in Maryland. Conduct financial examinations of insurance companies to ensure solvency. Conduct market conduct examinations to ensure compliance with Marylands insurance laws. Investigate acts of insurance fraud.

Who regulates insurance in Maryland?

The primary role of the Maryland Insurance Administration (MIA) is to protect consumers from illegal insurance practices by ensuring that insurers and producers that operate in Maryland act in ance with State insurance laws.

What is the jurisdiction of the Maryland Insurance Administration?

The Maryland Insurance Administration (MIA) has jurisdiction over all insurers, insurance producers (agents or brokers) premium finance companies, motor clubs and HMOs authorized or licensed to conduct business in Maryland.

What is the purpose of the Maryland insurance administration?

Protect Maryland consumers by regulating the states insurance companies and producers. Investigate complaints consumers have about their insurance coverage, including, but not limited to, life, health, automobile, and homeowners. License insurance companies and producers operating in Maryland.

What are the powers of the Maryland Commissioner of Insurance?

The Commissioner authorizes and licenses insurance companies, producers, adjusters, and advisors for fire, casualty, life, accident, health, title, bail bonds, and other insurance and annuities.