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<section article="gin" article_name="Insurance" number="15-1301" title_number="15" title_name="Health Insurance" subtitle_number="13" subtitle_name="Maryland Health Insurance Portability and Accountability Act -- Individual Market Reforms">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Affiliation period” means a period of time beginning on the date of enrollment and not to exceed 2 months, or 3 months in the case of a late enrollee, during which a health maintenance organization does not collect premium, and coverage issued does not become effective.</text>
  </level>
  <level label="c">
    <text>“Association” or “bona fide association” means an association that:</text>
    <level label="1">
      <text>has been actively in existence for at least 5 years;</text>
    </level>
    <level label="2">
      <text>has been formed and maintained in good faith for purposes other than obtaining insurance and does not condition membership on the purchase of association–sponsored insurance;</text>
    </level>
    <level label="3">
      <text>does not condition membership in the association on any health status–related factor relating to an individual, and states so clearly in all membership and application materials;</text>
    </level>
    <level label="4">
      <text>makes health insurance coverage offered through the association available to all members regardless of any health status–related factor relating to the members or individuals eligible for coverage and states so clearly in all membership and application materials;</text>
    </level>
    <level label="5">
      <text>does not make health insurance coverage offered through the association available other than in connection with membership in the association, and states so clearly in all marketing and application materials; and</text>
    </level>
    <level label="6">
      <text>provides and annually updates information necessary for the Commissioner to determine whether or not the association meets the definition of bona fide association before qualifying as an association under this subtitle.</text>
    </level>
  </level>
  <level label="d">
    <text>“Benefit year” means a calendar year in which a health benefit plan provides coverage for health benefits.</text>
  </level>
  <level label="e">
    <text>“Carrier” means a person that is:</text>
    <level label="1">
      <text>an insurer that holds a certificate of authority in the State and provides health insurance in the State;</text>
    </level>
    <level label="2">
      <text>a health maintenance organization that is licensed to operate in the State;</text>
    </level>
    <level label="3">
      <text>a nonprofit health service plan that is licensed to operate in the State; or</text>
    </level>
    <level label="4">
      <text>any other person or organization that provides health benefit plans subject to State insurance regulation.</text>
    </level>
  </level>
  <level label="f">
    <text>“Church plan” means a plan as defined under § 3(33) of the Employee Retirement Income Security Act of 1974.</text>
  </level>
  <level label="g">
    <text>“Eligible individual” means an individual who applies for or is covered under an individual health benefit plan.</text>
  </level>
  <level label="h">
    <text>“Employer sponsored plan” means an employee welfare benefit plan that provides medical care to employees or their dependents, and is not subject to State regulation in accordance with the federal Employee Retirement Income Security Act of 1974.</text>
  </level>
  <level label="i">
    <text>“Enrollment date” means the date on which:</text>
    <level label="1">
      <text>an individual enrolls in a health benefit plan; or</text>
    </level>
    <level label="2">
      <text>the first day of the waiting period before which the individual may enroll.</text>
    </level>
  </level>
  <level label="j">
    <text>“Governmental plan” means a plan as defined in § 3(32) of the Employee Retirement Income Security Act of 1974 and any federal governmental plan.</text>
  </level>
  <level label="k">
    <text>“Grandfathered health plan coverage” has the meaning stated in 45 C.F.R. § 147.140.</text>
  </level>
  <level label="l">
    <level label="1">
      <text>“Health benefit plan” means a:</text>
      <level label="i">
        <text>hospital or medical policy or certificate, including those issued under multiple employer trusts or associations located in Maryland or any other state covering Maryland residents;</text>
      </level>
      <level label="ii">
        <text>policy, contract, or certificate issued by a nonprofit health service plan that covers Maryland residents; or</text>
      </level>
      <level label="iii">
        <text>health maintenance organization subscriber or group master contract.</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; and</text>
        </level>
        <level label="7">
          <text>coverage for on–site medical clinics;</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 plan:</text>
        <level label="1">
          <text>limited scope dental or vision benefits; and</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;</text>
        </level>
      </level>
      <level label="iii">
        <text>coverage only for a specified disease or illness if offered as independent, noncoordinated benefits;</text>
      </level>
      <level label="iv">
        <text>hospital indemnity or other fixed indemnity insurance if:</text>
        <level label="1">
          <text>offered as independent, noncoordinated benefits;</text>
        </level>
        <level label="2">
          <text>the benefits are paid in a fixed dollar amount per period of hospitalization, illness, or service, regardless of the amount of expenses incurred and of the amount of benefits provided with respect to the event or service under any other health coverage; and</text>
        </level>
        <level label="3">
          <text>a notice is displayed prominently in the application materials, in at least 14 point type, that has the following language in capital letters: “This is a supplement to health insurance and is not a substitute for major medical coverage. Lack of major medical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.”; or</text>
        </level>
      </level>
      <level label="v">
        <text>the following benefits if offered as a separate insurance policy:</text>
        <level label="1">
          <text>Medicare supplemental health insurance (as defined under § 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 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="m">
    <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="n">
    <text>“Individual Exchange” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="o">
    <level label="1">
      <text>“Individual health benefit plan” means:</text>
      <level label="i">
        <text>a health benefit plan other than a converted policy or a professional association plan for eligible individuals and their dependents; or</text>
      </level>
      <level label="ii">
        <text>a certificate issued to an eligible individual that evidences coverage under a policy or contract issued to a trust or association or other similar group of individuals, regardless of the situs of delivery of the policy or contract, if the eligible individual pays the premium and is not being covered under the policy or contract under either federal or State continuation of benefits provisions.</text>
      </level>
    </level>
    <level label="2">
      <text>“Individual health benefit plan” does not include short–term limited duration insurance.</text>
    </level>
  </level>
  <level label="p">
    <text>“Minimum essential coverage” has the meaning stated in 45 C.F.R. § 155.20.</text>
  </level>
  <level label="q">
    <text>“Preexisting condition” means a condition that was present before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date.</text>
  </level>
  <level label="r">
    <text>“Qualified health plan” has the meaning stated in § 31–101 of this article.</text>
  </level>
  <level label="s">
    <text>“Short–term limited duration insurance” means health insurance coverage provided under a policy or contract with a carrier and that:</text>
    <level label="1">
      <text>has a policy term that is less than 3 months after the original effective date of the policy or contract;</text>
    </level>
    <level label="2">
      <text>may not be extended or renewed;</text>
    </level>
    <level label="3">
      <text>applies the same underwriting standards to all applicants regardless of whether they have previously been covered by short–term limited duration insurance; and</text>
    </level>
    <level label="4">
      <text>contains the notice required by federal law prominently displayed in the contract and in any application materials provided in connection with enrollment.</text>
    </level>
  </level>
  <level label="t">
    <text>“Waiting period” means the period of time that must pass before an individual is eligible to be covered for benefits under the terms of a group health benefit plan.</text>
  </level>
</section>
