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<section article="gin" article_name="Insurance" number="11-601" title_number="11" title_name="Insurance Rating Law" subtitle_number="6" subtitle_name="Health Benefit Plan Premium Rate Review">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Carrier” means a person that:</text>
    <level label="1">
      <text>offers a health benefit plan in the State; and</text>
    </level>
    <level label="2">
      <text>is:</text>
      <level label="i">
        <text>an insurer;</text>
      </level>
      <level label="ii">
        <text>a nonprofit health service plan; or</text>
      </level>
      <level label="iii">
        <text>a health maintenance organization.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>“Contract holder” means a person to which a carrier has issued a health benefit plan.</text>
  </level>
  <level label="d">
    <level label="1">
      <text>“Health benefit plan” means:</text>
      <level label="i">
        <text>a health insurance contract, a nonprofit health service plan contract, or a health maintenance organization contract that includes benefits for medical care; or</text>
      </level>
      <level label="ii">
        <text>a certificate of health insurance issued or delivered to a Maryland resident under a contract issued to an association located in the State or any other state.</text>
      </level>
    </level>
    <level label="2">
      <text>“Health benefit plan” does not include:</text>
      <level label="i">
        <text>one or more, or any combination of the following:</text>
        <level label="1">
          <text>coverage only for accident or disability income insurance;</text>
        </level>
        <level label="2">
          <text>coverage issued as a supplement to liability insurance;</text>
        </level>
        <level label="3">
          <text>liability insurance, including general liability insurance and automobile liability insurance;</text>
        </level>
        <level label="4">
          <text>workers’ compensation or similar insurance;</text>
        </level>
        <level label="5">
          <text>automobile medical payment insurance;</text>
        </level>
        <level label="6">
          <text>credit–only insurance;</text>
        </level>
        <level label="7">
          <text>coverage for on–site medical clinics; and</text>
        </level>
        <level label="8">
          <text>other similar insurance coverage, as specified in federal regulations issued pursuant to P.L. 104–191, under which benefits for medical care are secondary or incidental to other insurance benefits;</text>
        </level>
      </level>
      <level label="ii">
        <text>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 health benefit plan:</text>
        <level label="1">
          <text>limited scope dental or vision benefits;</text>
        </level>
        <level label="2">
          <text>benefits for long–term care, nursing home care, home health care, community–based care, or any combination of these benefits; and</text>
        </level>
        <level label="3">
          <text>other similar limited benefits as specified in federal regulations issued pursuant to P.L. 104–191;</text>
        </level>
      </level>
      <level label="iii">
        <text>the following benefits if offered as independent, noncoordinated benefits:</text>
        <level label="1">
          <text>coverage only for a specified disease or illness; and</text>
        </level>
        <level label="2">
          <text>hospital indemnity or other fixed indemnity insurance; or</text>
        </level>
      </level>
      <level label="iv">
        <text>the following benefits if offered as a separate policy, certificate, or contract of insurance:</text>
        <level label="1">
          <text>Medicare supplemental health insurance, as defined in § 1882(g)(1) of the Social Security Act;</text>
        </level>
        <level label="2">
          <text>coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and</text>
        </level>
        <level label="3">
          <text>similar supplemental coverage provided to coverage under an employer sponsored plan.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="e">
    <text>“Medical care” means:</text>
    <level label="1">
      <text>items or services for the diagnosis, cure, mitigation, treatment, or prevention of a disease, injury, or condition affecting any structure or function of the body; and</text>
    </level>
    <level label="2">
      <text>transportation primarily for and essential to medical care described in item (1) of this subsection.</text>
    </level>
  </level>
</section>
