Md. Code Regs. 31.11.01.02

Current through Register Vol. 51, No. 12, June 14, 2024

Section 31.11.01.02 - Definitions

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

B. Terms Defined.

(1) "Carrier" means:

(a) An insurer as defined in Insurance Article, § 1-101, Annotated Code of Maryland; or

(b) A nonprofit health service plan that is licensed to operate in Maryland.

(2) "Converted policy" means an individual policy or certificate issued to an individual in accordance with the requirements of this chapter upon termination of the individual's coverage under a group policy.

(3) Expense Incurred.

(a) "Expense incurred" means that the benefits payable under the contract are based on the medical expenses that the covered person incurs.

(b) For the purposes of this chapter, a contract that includes both expense-incurred benefits and indemnity benefits shall be considered to be written on an "expense-incurred" basis.

(4) "Group health insurance policy" or "group policy" means either:

(a) An insurance contract issued by an insurer under Insurance Article, § 15-302, Annotated Code of Maryland, that insures employees or members, with or without their dependents, for hospital, surgical, medical, or major medical insurance on an expense-incurred basis; or

(b) A contract issued by a nonprofit health service plan to a group that insures employees or members, with or without their dependents, for hospital, medical, major medical, or surgical insurance on an expense-incurred basis.

(5) "Indemnity" means that the benefits payable under the contract are set amounts that are not related to the expenses the covered person incurs, such as a hospital indemnity policy that pays a flat fee for each day the covered person is confined in a hospital, regardless of the actual expenses the covered person incurs during the hospital confinement.

(6) "Insured person" means:

(a) An employee, a member, or another certificate holder covered under the group policy; or

(b) Any eligible dependent of the employee, member, or certificate holder covered under the group policy.

(7) "Medicare" means Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded.

Md. Code Regs. 31.11.01.02

Regulation .02C adopted effective May 6, 1996 (23:9 Md. R. 670)