Md. Code Regs. 31.11.05.02

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

Section 31.11.05.02 - Definitions

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

B. Terms Defined.

(1) "Alzheimer's disease" means a progressive brain disease diagnosed as Alzheimer's disease by the insured's licensed attending physician and confirmed by a second opinion of a licensed physician.

(2) "Diseases of the elderly" means any disease, illness, injury, or medical condition which has caused the elderly insured to become functionally impaired or disabled so as to require nursing home care or intermediate or custodial nursing care and which has been confirmed by a second opinion of a licensed physician.

(3) "Elderly" means an insured who is 65 years old or older.

(4) "Group health insurance policy" means an insurance policy issued in Maryland either:

(a) Providing benefits for hospital, surgical, medical, major medical, or all of the above, in accordance with Insurance Article, § 15-302, Annotated Code of Maryland; or

(b) Providing benefits for health, surgical, medical, major medical, or all of the above to a group of persons by a nonprofit health service plan, pursuant to Insurance Article, Title 14, Subtitle 1, Annotated Code of Maryland.

(5) "Group of persons" means the types of groups as defined in Insurance Article, § 15-302, Annotated Code of Maryland.

(6) "Insured" means a person covered under a group health insurance policy.

(7) "Intermediate or custodial nursing care" means any form of health or health-related service, whether provided in a custodial or noncustodial setting, which is designed to provide therapeutic, rehabilitative, supportive, or maintenance care to a person who has chronic or deteriorating medical conditions which impair the person's ability to function at his or her own optimum level, but not including treatment of the conditions during the initial, acute stage of the condition or conditions.

(8) "Nursing home" means a facility or institution or part of it that:

(a) Provides nursing care for chronically ill or convalescent patients; or

(b) Offers to provide 24-hour a day nursing care of patients in a home-type facility such as a:

(i) Convalescent home,

(ii) Nursing unit of a home for the aged,

(iii) Psychiatric nursing home,

(iv) Nursing facility for the handicapped,

(v) Home for alcoholics, or

(vi) Halfway house.

Md. Code Regs. 31.11.05.02