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<section article="gin" article_name="Insurance" number="15-1201" title_number="15" title_name="Health Insurance" subtitle_number="12" subtitle_name="Maryland Health Insurance Reform Act">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Board” means the Board of Directors of the Pool established under § 15–1216 of this subtitle.</text>
  </level>
  <level label="c">
    <text>“Carrier” means a person that:</text>
    <level label="1">
      <text>offers health benefit plans in the State covering eligible employees of small employers; and</text>
    </level>
    <level label="2">
      <text>is:</text>
      <level label="i">
        <text>an authorized insurer that provides health insurance in the State;</text>
      </level>
      <level label="ii">
        <text>a nonprofit health service plan that is licensed to operate in the State;</text>
      </level>
      <level label="iii">
        <text>a health maintenance organization that is licensed to operate in the State; or</text>
      </level>
      <level label="iv">
        <text>any other person or organization that provides health benefit plans subject to State insurance regulation.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>“Commission” means the Maryland Health Care Commission established under Title 19, Subtitle 1 of the Health – General Article.</text>
  </level>
  <level label="e">
    <text>“Coverage level” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="f">
    <level label="1">
      <text>“Eligible employee” means an employee who is offered coverage under a health benefit plan by a small employer.</text>
    </level>
    <level label="2">
      <text>“Eligible employee”, at the option of the small employer, may include:</text>
      <level label="i">
        <text>only full–time employees; or</text>
      </level>
      <level label="ii">
        <text>full–time employees and part–time employees.</text>
      </level>
    </level>
  </level>
  <level label="g">
    <text>“Employee” means an individual who is employed by a small employer.</text>
  </level>
  <level label="h">
    <level label="1">
      <text>“Full–time employee” means, with respect to a calendar month, an employee of a small employer who works, on average, at least 30 hours per week.</text>
    </level>
    <level label="2">
      <text>“Full–time employee” does not include a seasonal employee as defined in federal law.</text>
    </level>
  </level>
  <level label="i">
    <level label="1">
      <text>“Health benefit plan” means:</text>
      <level label="i">
        <text>a policy or certificate for hospital or medical benefits issued by an insurer;</text>
      </level>
      <level label="ii">
        <text>a nonprofit health service plan contract; or</text>
      </level>
      <level label="iii">
        <text>a health maintenance organization subscriber or group master contract.</text>
      </level>
    </level>
    <level label="2">
      <text>“Health benefit plan” includes a policy or certificate for hospital or medical benefits that covers residents of this State who are eligible employees and that is issued through:</text>
      <level label="i">
        <text>a multiple employer trust or association located in this State or another state; or</text>
      </level>
      <level label="ii">
        <text>a professional employer organization, coemployer, or other organization located in this State or another state that engages in employee leasing.</text>
      </level>
    </level>
    <level label="3">
      <text>“Health benefit plan” does not include:</text>
      <level label="i">
        <text>accident–only insurance;</text>
      </level>
      <level label="ii">
        <text>credit health insurance;</text>
      </level>
      <level label="iii">
        <text>disability income insurance;</text>
      </level>
      <level label="iv">
        <text>coverage issued as a supplement to liability insurance;</text>
      </level>
      <level label="v">
        <text>workers’ compensation or similar insurance;</text>
      </level>
      <level label="vi">
        <text>automobile medical payment insurance;</text>
      </level>
      <level label="vii">
        <text>the following benefits, if the benefits are provided under a separate policy, certificate, or contract, or are not otherwise an integral part of a small employer health benefit plan:</text>
        <level label="1">
          <text>dental benefits;</text>
        </level>
        <level label="2">
          <text>vision benefits; or</text>
        </level>
        <level label="3">
          <text>long–term care insurance as defined in § 18–101 of this article;</text>
        </level>
      </level>
      <level label="viii">
        <text>disease–specific insurance if:</text>
        <level label="1">
          <text>the benefits are provided under a separate policy, certificate, or contract;</text>
        </level>
        <level label="2">
          <text>there is no coordination between the provision of the benefits and an exclusion of benefits under any group health plan maintained by the same employer; and</text>
        </level>
        <level label="3">
          <text>the benefits are paid with respect to an event, without regard to whether benefits are provided with respect to the event under any group health plan maintained by the same employer;</text>
        </level>
      </level>
      <level label="ix">
        <text>hospital indemnity or other fixed indemnity insurance if:</text>
        <level label="1">
          <text>the benefits are provided under a separate policy, certificate, or contract;</text>
        </level>
        <level label="2">
          <text>there is no coordination between the provision of the benefits and an exclusion of benefits under any group health plan maintained by the same employer;</text>
        </level>
        <level label="3">
          <text>the benefits are paid with respect to an event, without regard to whether benefits are provided with respect to the event under any group health plan maintained by the same employer; and</text>
        </level>
        <level label="4">
          <text>the benefits are payable in a fixed dollar amount per period of time, regardless of the amount of expenses incurred; or</text>
        </level>
      </level>
      <level label="x">
        <text>the following supplemental benefits, if the benefits are provided under a separate policy, certificate, or contract:</text>
        <level label="1">
          <text>a Medicare supplement policy as defined in § 15–901 of this title;</text>
        </level>
        <level label="2">
          <text>coverage supplemental to the coverage provided under Chapter 55, Title 10 of the United States Code; and</text>
        </level>
        <level label="3">
          <text>similar supplemental coverage provided to coverage under a group health plan if the coverage qualifies for the exception described in 45 C.F.R. § 146.145(b)(5)(i)(C).</text>
        </level>
      </level>
    </level>
  </level>
  <level label="j">
    <text>“Health care practitioner” has the meaning stated in § 1–301 of the Health Occupations Article.</text>
  </level>
  <level label="k">
    <text>“Health status–related factor” means a factor related to:</text>
    <level label="1">
      <text>health status;</text>
    </level>
    <level label="2">
      <text>medical condition;</text>
    </level>
    <level label="3">
      <text>claims experience;</text>
    </level>
    <level label="4">
      <text>receipt of health care;</text>
    </level>
    <level label="5">
      <text>medical history;</text>
    </level>
    <level label="6">
      <text>genetic information;</text>
    </level>
    <level label="7">
      <text>evidence of insurability including conditions arising out of acts of domestic violence; or</text>
    </level>
    <level label="8">
      <text>disability.</text>
    </level>
  </level>
  <level label="l">
    <text>“Late enrollee” means an eligible employee or dependent who requests enrollment in a health benefit plan after the initial enrollment period provided under the health benefit plan.</text>
  </level>
  <level label="m">
    <text>“Minimum essential coverage” has the meaning stated in 45 C.F.R. § 155.20.</text>
  </level>
  <level label="n">
    <text>“Part–time employee” means an employee of a small employer who:</text>
    <level label="1">
      <text>has a normal workweek of at least 17.5 hours; and</text>
    </level>
    <level label="2">
      <text>is not a full–time employee.</text>
    </level>
  </level>
  <level label="o">
    <text>“Plan year” means a calendar year or other consecutive 12–month period during which a health benefit plan provides coverage for health care services.</text>
  </level>
  <level label="p">
    <text>“Pool” means the Maryland Small Employer Health Reinsurance Pool established under this subtitle.</text>
  </level>
  <level label="q">
    <text>“Preexisting condition” means:</text>
    <level label="1">
      <text>a condition existing during a specified period immediately preceding the effective date of coverage, that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment; or</text>
    </level>
    <level label="2">
      <text>a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.</text>
    </level>
  </level>
  <level label="r">
    <text>“Preexisting condition provision” means a provision in a health benefit plan that denies, excludes, or limits benefits for an enrollee for expenses or services related to a preexisting condition.</text>
  </level>
  <level label="s">
    <text>“Qualified employer” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="t">
    <text>“Qualified health plan” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="u">
    <text>“Reinsuring carrier” means a carrier that participates in the Pool.</text>
  </level>
  <level label="v">
    <text>“Risk–assuming carrier” means a carrier that does not participate in the Pool.</text>
  </level>
  <level label="w">
    <text>“SHOP Exchange” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="x">
    <text>“Small employer” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="y">
    <text>“Special enrollment period” means a period during which a group health plan shall permit certain individuals who are eligible for coverage, but not enrolled, to enroll for coverage under the terms of the group health benefit plan.</text>
  </level>
  <level label="z">
    <text>“Standard Plan” means the Comprehensive Standard Health Benefit Plan adopted by the Commission in accordance with § 15–1207 of this subtitle and Title 19, Subtitle 1 of the Health – General Article.</text>
  </level>
  <level label="aa">
    <text>“Wellness benefit” means a benefit that:</text>
    <level label="1">
      <text>includes a bona fide wellness program as defined in § 15–509 of this title; and</text>
    </level>
    <level label="2">
      <text>complies with regulations adopted by the Commission.</text>
    </level>
  </level>
  <level label="bb">
    <level label="1">
      <text>“Wellness program” means a program or activity that:</text>
      <level label="i">
        <text>is designed to improve health status and reduce health care costs; and</text>
      </level>
      <level label="ii">
        <text>complies with guidelines developed by the Commission.</text>
      </level>
    </level>
    <level label="2">
      <text>“Wellness program” includes programs and activities for:</text>
      <level label="i">
        <text>smoking cessation;</text>
      </level>
      <level label="ii">
        <text>reduction of alcohol misuse;</text>
      </level>
      <level label="iii">
        <text>weight reduction;</text>
      </level>
      <level label="iv">
        <text>nutrition education; and</text>
      </level>
      <level label="v">
        <text>automobile and motorcycle safety.</text>
      </level>
    </level>
  </level>
</section>
