Md. Code Regs. 31.12.07.02

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

Section 31.12.07.02 - Definitions

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

B. Terms Defined.

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

(1-1) Group Contract.

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

(i) Subscribers of the group contract holder; or

(ii) Subscribers of the group contract holder and the subscriber's dependents.

(b) "Group contract" includes a small employer health benefit plan as defined in Insurance Article, § 15-1201, Annotated Code of Maryland.

(2) "Group contract holder" means the entity to whom the group contract is issued.

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

(4) "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 covering:

(a) The subscriber;

(b) The subscriber and the subscriber's dependents; or

(c) The subscriber's dependents.

(5) "Member" means an individual entitled to receive health care benefits from the HMO under an individual or group contract.

(6) "Subscriber" means for:

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

(b) Individual contracts, the individual to whom the HMO contract is issued.

Md. Code Regs. 31.12.07.02

Regulation .02B amended effective October 18, 2010 (37:21 Md. R. 1439)