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<section article="gin" article_name="Insurance" number="15-1401" title_number="15" title_name="Health Insurance" subtitle_number="14" subtitle_name="Maryland Health Insurance Portability and Accountability Act -- Large Group Market Reforms">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Association” or “bona fide association” means, with respect to health insurance coverage offered in this State, 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 through a member 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="c">
    <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="d">
    <text>“Church plan” means a plan as defined under § 3(33) of the Employee Retirement Income Security Act of 1974.</text>
  </level>
  <level label="e">
    <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="f">
    <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="g">
    <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="h">
    <level label="1">
      <text>“Health benefit plan” means any:</text>
      <level label="i">
        <text>hospital or medical policy, 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 or contract 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;</text>
        </level>
        <level label="7">
          <text>coverage for on–site medical clinics; and</text>
        </level>
        <level label="8">
          <text>other similar insurance coverage, specified in federal regulations issued under the federal Health Insurance Portability and Accountability Act, 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 the 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>such other similar, limited benefits as are specified in federal regulations issued under the federal Health Insurance Portability and Accountability Act;</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, if 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="iv">
        <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 an employer sponsored 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="i">
    <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="j">
    <text>“Late enrollee” means a member, subscriber, or dependent who enrolls in a group health benefit plan other than during:</text>
    <level label="1">
      <text>the first period in which the individual is eligible to enroll under the plan; or</text>
    </level>
    <level label="2">
      <text>a special enrollment period.</text>
    </level>
  </level>
  <level label="k">
    <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="l">
    <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="m">
    <text>“Secretary” means the Secretary of the federal Department of Health and Human Services.</text>
  </level>
  <level label="n">
    <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="o">
    <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>
