Md. Code Regs. 31.17.02.02

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

Section 31.17.02.02 - Definitions

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

B. Terms Defined.

(1) "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.

(2) "Medical or health condition" means any of the following:

(a) Acquired immunodeficiency syndrome (AIDS);

(b) Addison's disease;

(c) Amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease);

(d) Alzheimer's disease;

(e) Angina pectoris;

(f) Ankylosing Spondylitis;

(g) Anorexia;

(h) Aplastic anemia;

(i) Ascites;

(j) Banti's disease;

(k) Behavioral health in-patient treatment within the last 12 months;

(l) Bipolar disorder;

(m) Bulimia;

(n) Cancer treated or diagnosed within the last 5 years, except skin cancer;

(o) Cardiomyopathy;

(p) Chemical dependency;

(q) Chronic obstructive pulmonary disease;

(r) Cirrhosis of the liver;

(s) Coronary artery disease;

(t) Coronary heart failure;

(u) Coronary insufficiency;

(v) Coronary occlusion;

(w) Creutzfeldt-Jakob disease;

(x) Crohn's disease;

(y) Cystic fibrosis;

(z) Dementia;

(aa) Type I or II diabetes;

(bb) Disorders from organic brain damage;

(cc) Emphysema;

(dd) Esophageal varices;

(ee) Friederich's ataxia;

(ff) Guillain-Barramp;Atilde;© syndrome;

(gg) Hemochromatosis;

(hh) Hemophilia;

(ii) Hepatitis B or C;

(jj) Hodgkin's disease;

(kk) Human immunodeficiency virus (HIV);

(ll) Huntington's chorea;

(mm) Hydrocephalus;

(nn) Kidney disease requiring dialysis;

(oo) Leukemia;

(pp) Lupus erythematosus disseminate;

(qq) Major organ transplant recipient;

(rr) Melanoma;

(ss) Multiple myeloma;

(tt) Multiple or disseminated sclerosis;

(uu) Muscular dystrophy;

(vv) Myasthenia gravis;

(ww) Myotonia;

(xx) Non-Hodgkin's lymphoma;

(yy) Palsy;

(zz) Paraplegia;

(aaa) Parkinson's disease;

(bbb) Pick's disease;

(ccc) Porphyria;

(ddd) Pregnancy;

(eee) Presence of a pacemaker;

(fff) Psychotic disorder;

(ggg) Quadriplegia;

(hhh) Rheumatoid arthritis;

(iii) Scleroderma;

(jjj) Sickle cell disease;

(kkk) Cerebrovascular accident (stroke);

(lll) Syringomyelia;

(mmm) Tay-Sachs disease;

(nnn) Ulcerative colitis;

(ooo) Wernicke-Kosakoff syndrome;

(ppp) Wilm's tumor; or

(qqq) Wilson's disease.

(3) Medically Uninsurable Individual.

(a) "Medically uninsurable individual" means an individual who is a resident of the State and who:

(i) Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual;

(ii) Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual, except at a rate that exceeds the Plan rate;

(iii) Is an eligible individual under Insurance Article, § 15-1301, Annotated Code of Maryland;

(iv) Has a history of or suffers from a medical or health condition as defined in §B(2) of this regulation; or

(v) Is a dependent of an individual who is eligible for coverage under this subsection.

(b) "Medically uninsurable individual" does not include an individual who is eligible for coverage under:

(i) The federal Medicare program;

(ii) The Maryland Medical Assistance Program;

(iii) The Maryland Children's Health Program; or

(iv) An employer-sponsored group health insurance plan that includes benefits comparable to Plan benefits.

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

Md. Code Regs. 31.17.02.02

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)
Regulation .02B amended effective January 30, 2006 (33:2 Md. R. 85); May 5, 2008 (35:9 Md. R. 900); December 29, 2008 (35:26 Md. R. 2251)