Md. Code Regs. 14.35.15.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.15.02 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) 'Active carrier business agreement" means the most recent version of the carrier business agreement provided by the Exchange, signed by the Exchange and the carrier, and on file with the Exchange.

(2) "Active non-exchange entity agreement" means the most recent version of the non-exchange entity agreement provided by the Exchange, signed by the Exchange and the carrier, and on file with the Exchange.

(3) "Authorized carrier" means a carrier that holds a current certification of authorization issued by the Exchange as set forth in Regulation .03 of this chapter.

(4) "Carrier business agreement" means the agreement between the Exchange and the carrier that contains terms and conditions governing compliance with the Annotated Code of Maryland, Exchange policies, and State and federal regulations.

(5) "Carrier reference manual" means the document developed by the Exchange that provides business rules and operational instructions to authorized carriers participating on the Exchange.

(6) "Health maintenance organization (HMO)" has the meaning stated in Health-General Article, § 19-701(g), Annotated Code of Maryland.

(7) "Member" means a qualified individual or qualified employee enrolled in a QHP with a particular authorized carrier through the Exchange.

(8) Member Level Report.

(a) "Member level report" means a report of the carrier's QHP member enrollment files with the Exchange at a specified time.

(b) "Member level report" includes:

(i) Information demonstrating the member enrolled through the Exchange;

(ii) The coverage effective date;

(iii) The coverage termination date, if applicable;

(iv) The termination reason, if applicable;

(v) The premium amount; and

(vi) The amount of advanced premium tax credits, if applicable.

(9) "Metal level" means a QHP at the bronze, silver, gold, or platinum coverage level.

(10) "Non-exchange entity agreement" means the agreement between the Exchange and the carrier that contains privacy and security provisions.

(11) "SERFF binder" means the portfolio of information that State laws and regulations require carriers to submit to the Exchange through SERFF.

(12) "System companion guide" means the document developed by the Exchange that provides instructions to authorized carriers to process enrollment information through electronic data transactions between the Exchange and the carrier.

(13) "System for Electronic Rate and Form Filing (SERFF) " means the online system the Exchange and the Administration use to accept, review, and approve carrier product and rate filings.

Md. Code Regs. 14.35.15.02

Regulation .02 adopted effective 46:5 Md. R. 308, eff. 3/11/2019