Md. Code Regs. 31.12.02.02

Current through Register Vol. 52, No. 1, January 10, 2025

Section 31.12.02.02 - Definitions

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

B. Terms Defined.

(1) "Advertising" means:

(a) Printed and published material;

(b) Descriptive literature and sales aids;

(c) Sales talks;

(d) Sales materials, booklets, forms, pamphlets, brochures, illustrations, depictions, and form letters;

(e) Newspaper, radio, television, or direct mail advertising; and

(f) Any other material used for the promotion of enrollment.

(2) "Carrier" means:

(a) An HMO;

(b) An insurer;

(c) A nonprofit health service plan;

(d) A dental plan organization; or

(e) A fraternal benefit society.

(3) Contract on an Insert Page Basis.

(a) "Contract on an insert page basis" means a contract that is composed of insert pages, with each insert page being identified with a unique form number.

(b) "Contract on an insert page basis" does not include a contract that contains an insert that is identified with a unique form number and is longer than one page.

(4) Contract on a Sectional Basis.

(a) "Contract on a sectional basis" means a contract that is composed of sections, with each section being identified with a unique form number.

(b) "Contract on a sectional basis" includes a contract that contains sections that are only one page long.

(5) Form.

(a) "Form" means:

(i) A policy;

(ii) A contract;

(iii) A certificate;

(iv) A rider;

(v) An endorsement; or

(vi) An application.

(b) "Form" does not include a provider contract.

(6) "Group certificate" means the description of benefits and rights which pertain to the members covered under a group policy.

(7) "Group contract" or "group policy" means a contractual agreement entered into between an HMO and an employer, union, trustee, association, or organization for the provision of health care services on a prepaid basis to:

(a) Subscribers; or

(b) Subscribers and the subscriber's dependents, family members, or both.

(8) "HMO" means a health maintenance organization.

(9) "Individual contract" means a contractual agreement for the provision of health care services on a prepaid basis entered into between an HMO and a subscriber, provided the contract covers only the following persons:

(a) The subscriber;

(b) The subscriber and the subscriber's dependents, family members, or both; or

(c) The subscriber's dependents, family members, or both.

(10) "Member" means the subscriber and any of the subscriber's dependents or family members who are entitled to receive health care benefits from the HMO.

(11) "Subscriber" means for:

(a) Group contracts, the person who is eligible to be covered under the contract, other than as a dependent or a family member by reason of satisfying the eligibility requirements of the group contract; and

(b) Individual contracts, the person who completes the application for coverage with the HMO and who is covered under the contract.

Md. Code Regs. 31.12.02.02

Regulation .02 amended effective April 1, 1991 (18:6 Md. R. 684)