Carrier
A health insurance carrier that issues or delivers policies, plans, or certificates in Maryland.
How the laws define this
Both legal instruments agree that the concept centers on health insurance entities operating within Maryland. They share a core focus on health coverage entities regulated or active in the state. However, the instruments diverge significantly in how they define the boundaries and specific forms of these entities. Under [Health Insurance – Utilization Review – Use of Artificial Intelligence], the definition focuses on a health insurance carrier based on its specific activity of issuing or delivering policies, plans, or certificates in Maryland. Conversely, [Emergency Room Services and Post-Acute Care - Coverage and Facility Studies] establishes a broader, entity-based definition that encompasses a health insurance issuer, a nonprofit health service plan, a health maintenance organization (HMO), or any other entity regulated by the Maryland Insurance Administration. As a result, the former instrument identifies carriers by the act of issuing or delivering coverage plans, while the latter defines them by their organizational type and oversight by the state insurance administration.
Synthesised from the 2 statutory definitions below. Each one is quoted in full, with its source.
How jurisdictions differ
What is distinctive in each definition, binding law in force first.
| Jurisdiction | Instrument | Status | What is distinctive |
|---|---|---|---|
| Maryland, United States | Health Insurance – Utilization Review – Use of Artificial Intelligence | In Force | This definition limits carrier to a health insurance carrier that issues or delivers policies, plans, or certificates specifically in Maryland. |
| Maryland, United States | Emergency Room Services and Post-Acute Care - Coverage and Facility Studies | In Force | This definition widens carrier to include a health insurance issuer, nonprofit health service plan, health maintenance organization or other entity regulated by the Maryland Insurance Administration. |
What it triggers
- In Maryland, under HB 820, it prohibits AI from denying care and mandates human oversight and patient-specific decisions in health insurance utilization review.source
- In Maryland, under HB 1563, it requires reporting of AI usage in adverse coverage decisions for transparency and consumer protection.source
Definitions (2)
A health insurance carrier that issues or delivers policies, plans, or certificates in Maryland.
A health insurance issuer, nonprofit health service plan, health maintenance organization (HMO), or other entity regulated by the Maryland Insurance Administration.
Questions and answers
What obligations does a carrier have under Maryland HB 820?
Under Maryland HB 820, a carrier must ensure AI is not used to deny care in utilization review. It mandates human oversight and patient-specific decisions.
Who is considered a carrier under Maryland HB 1563 for AI reporting?
A carrier includes a health insurance issuer, nonprofit health service plan, HMO, or other entity regulated by the Maryland Insurance Administration. They must report AI usage in adverse coverage decisions.
How do the definitions of carrier differ between Maryland HB 820 and HB 1563?
HB 820 defines it narrowly as a health insurance carrier issuing policies in Maryland. HB 1563 broadens it to issuers, nonprofit plans, HMOs, and other regulated entities.