A health maintenance organization is a type of health insurance plan that limits coverage to care from doctors who work for, or are under contract with the HMO.  Care is directed by the enrollee’s primary care provider who provides referrals for diagnostics and specialty providers. Health Maintenance Organization are insurance plans and are authorized to do business under certification by the Maryland Insurance Administration.  An HMO generally won’t cover or has limited coverage for out-of-network care, except in an emergency.  The purpose of these regulations is to regulate various phases of the operations of health maintenance organizations in accordance with the mandates of Health-General Article, §§19-701—19-734, Annotated Code of Maryland.

OHCQ is responsible for the oversight of the quality of care in HMOs and conducts initial surveys, periodic surveys, and complaint investigations. OHCQ's oversight does not extend to Medicare Advantage plans, Medicaid Managed Care Organizations, or Federal Employee Managed Care plans operated by HMOs. The Maryland Insurance Administration is the single point of entry for all complaints and applications for certificate.

Regulations related to HMOs are found in COMAR 10.07.11  To order copies of COMAR regulations, contact Tarshia Neal at the Maryland Division of State Documents at 410-260-3874 or [email protected].  Regulations are also available at public libraries - Find your nearest public library​.

The Maryland Insurance Administration issues a certificate to operate HMOs and acts as the single point of entry for all complaints to the State government filed by an HMO enrollee.  The Maryland Insurance Administration refers all quality of care complaints to OHCQ for investigation. The Maryland Insurance Administration refers qualified applicants to the Office of Health Care Quality.