Md. Code Regs. 31.10.25.02

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.25.02 - Definitions

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

B. Terms Defined.

(1) "Carrier" means a nonprofit health service plan.

(2) "Covered individual" means an individual covered under an individual contract.

(2-1) "Coverage period" means the interval of time the individual contract provides protection to the insured, in exchange for the payment of a particular premium.

(2-2) "Health benefit plan" has the meaning stated in Insurance Article, § 15-1301, Annotated Code of Maryland.

(3) "Individual contract" means a contract issued by a nonprofit health service plan to a subscriber covering:

(a) The subscriber;

(b) The subscriber's dependents; or

(c) The subscriber and the subscriber's dependents.

(4) "Preferred provider" means a provider that has entered into a provider service contract.

(5) "Preferred provider benefit" means a benefit that appears in an individual contract under which health care services are to be provided to the covered individual by a preferred provider.

(6) "Provider service contract" means a contract between a provider and a carrier or other entity, under which the provider agrees to provide health care services on a preferential basis under contracts containing preferred provider benefits.

(7) "Subscriber" means the individual to whom the nonprofit health service plan contract is issued.

Md. Code Regs. 31.10.25.02

Regulation .02B amended effective October 18, 2010 (37:21 Md. R. 1438); amended effective 43:9 Md. R. 532, eff. 5/9/2016