Md. Code Regs. 31.17.01.02

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

Section 31.17.01.02 - Definitions

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

B. Terms Defined.

(1) "Administrator" means:

(a) A person that is registered as an Administrator under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland; or

(b) A carrier.

(2) "Board" means the Board of Directors for the Maryland Health Insurance Plan.

(3) "Carrier" means:

(a) An authorized insurer that provides health insurance in the State;

(b) A nonprofit health service plan that is licensed to operate in the State; or

(c) A health maintenance organization that is licensed to operate in the State.

(4) Health Plan.

(a) "Health plan" means any:

(i) Contract providing hospital, medical, or surgical benefits on an expense incurred basis issued by an insurer;

(ii) Contract issued by a nonprofit health service plan;

(iii) Contract issued by a health maintenance organization; or

(iv) Employer-sponsored plan that provides health benefits to the employees of the employer.

(b) "Health plan" does not include one or more, or any combination of the following:

(i) Coverage only for accident or disability insurance;

(ii) Coverage issued as a supplement to liability insurance;

(iii) Coverage only for travel insurance;

(iv) Liability insurance, including general liability insurance and automobile liability insurance;

(v) Workers' compensation or similar insurance;

(vi) Automobile medical payment insurance;

(vii) Credit-only insurance; or

(viii) Coverage for on-site medical clinics.

(c) "Health plan" does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of a plan:

(i) Limited scope dental or vision benefits;

(ii) Benefits for long-term care, nursing home care, home health care, community based care, or any combination of these benefits;

(iii) Coverage only for a specified disease or illness; or

(iv) Hospital indemnity or other fixed indemnity insurance.

(d) "Health plan" does not include the following benefits if offered as a separate insurance policy:

(i) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act;

(ii) Coverage supplemental to the coverage provided under 10 U.S.C. Chapter 55; or

(iii) Coverage that is similar to the supplemental coverage described in §B(4)(d)(i) and (ii) of this regulation, which is provided as supplemental coverage under an employer sponsored plan.

(5) "Managed care organization" has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland.

(6) "Member" means an individual covered under the Plan.

(7) "Plan" means the Maryland Health Insurance Plan.

(8) "Plan Administrator" means the Administrator selected by the Board to administer the Plan.

(9) "Private review agent" has the meaning stated in Insurance Article, § 15-10 B-01(k), Annotated Code of Maryland.

(10) "Utilization review" means a system for reviewing the appropriate and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients.

Md. Code Regs. 31.17.01.02

Regulations .02 adopted as an emergency provision effective February 6, 2003 (30:5 Md. R. 365); adopted permanently effective August 4, 2003 (30:15 Md. R. 993)