Md. Code Regs. 31.14.03.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.14.03.02 - Definitions

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

B. Terms Defined.

(1) "Applicant" means:

(a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and

(b) In the case of a group long-term care insurance policy, the proposed certificate holder.

(2) "Carrier" means an insurer or a nonprofit health service plan.

(3) "Certificate" means any certificate issued under a group long-term care insurance policy, if the certificate is delivered or issued for delivery in Maryland.

(4) "Commissioner" has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(5) "Department" has the meaning stated in Health-General Article, §1-101, Annotated Code of Maryland.

(6) "Insured" means an individual who is covered under a partnership policy.

(7) "Insurer" has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(8) Long-Term Care Insurance.

(a) "Long-term care insurance" means any group or individual insurance policy, contract, certificate, or rider issued, delivered, or offered by a carrier that:

(i) Is advertised, marketed, offered, or designed to provide coverage for not less than 24 consecutive months for covered persons on an expense incurred, indemnity, prepaid, or insured basis; and

(ii) Provides one or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services furnished in a situation other than an acute care unit of a hospital.

(b) "Long-term care insurance" includes any product that is advertised, marketed, or offered as long-term care insurance.

(c) "Long-term care insurance" does not include any insurance policy, contract, certificate, or rider which is offered primarily to provide:

(i) Basic Medicare supplement coverage;

(ii) Hospital confinement indemnity coverage;

(iii) Basic hospital expense or medical-surgical expense coverage;

(iv) Disability income protection coverage;

(v) Accident only coverage;

(vi) Specified disease or specified accident coverage; or

(vii) Skilled nursing care.

(d) "Long-term care insurance" does not include a life insurance policy:

(i) That accelerates the death benefit specifically for one or more of the qualifying events of terminal illness, a medical condition requiring extraordinary medical intervention, or permanent institutional confinement;

(ii) That provides a lump sum payment for any of the events in §B(8)(d)(i) of this regulation; or

(iii) In which neither benefits nor eligibility for benefits is conditioned on receipt of long-term care.

(9) "Medicaid" means the Maryland Medical Assistance Program.

(10) "Nonprofit health service plan" means an entity that holds a certificate of authority from the Commissioner to act as a nonprofit health service plan in Maryland.

(11) "Partnership policy" or "partnership coverage" means a long-term care insurance policy that is:

(a) Certified by the Commissioner to meet the requirements under § 1917(b) of the Social Security Act; and

(b) Issued on or after the effective date of the State plan amendment.

(12) Policy.

(a) "Policy" means any policy, contract, individual certificate, subscriber agreement, rider, or endorsement delivered or issued for delivery in this State by a carrier.

(b) "Policy" does not include a life insurance policy that contains an optional provision for acceleration of payment of all or a portion of the face amount under stated conditions relating to the medical condition, the disability, or the need for long-term care of the insured.

(13) "Qualified long-term care insurance" has the meaning stated in COMAR 31.14.01.02C.

(14) "State plan amendment" means an amendment filed by the Department with the Centers for Medicare and Medicaid Services under Title 42, U.S.C., which provides for the disregard of any assets or resources by the Department in an amount equal to the insurance benefit payments that are made to, or on behalf of, the individual who is covered under a partnership policy.

Md. Code Regs. 31.14.03.02