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<regulation prefix="Regulation" num=".02" citation="COMAR 10.25.08.02" title_num="10" subtitle_num="25" chapter_num="08" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Carrier” means an insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accordance with Insurance Article, Annotated Code of Maryland, or a health maintenance organization that holds a certificate of authority in the State.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Commission” means the Maryland Health Care Commission.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Health Benefit Plan.</text>
      <paragraph num="(a)">
        <text>“Health benefit plan” means a hospital or medical policy, contract, or certificate issued by a carrier.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Health benefit plan” does not include:</text>
        <paragraph num="(i)">
          <text>Coverage for accident or disability income insurance;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Coverage issued as a supplement to liability insurance;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Liability insurance, including general liability insurance and automobile liability insurance;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Workers’ compensation or similar insurance;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Automobile or property medical payment insurance;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Credit-only insurance;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Coverage for on–site medical clinics;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Dental or vision insurance;</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Long-term care insurance or benefits for nursing home care, home health care, community-based care, or any combination of these;</text>
        </paragraph>
        <paragraph num="(x)">
          <text>Coverage only for a specified disease or illness;</text>
        </paragraph>
        <paragraph num="(xi)">
          <text>Hospital indemnity or other fixed indemnity insurance or a hospital or medical policy, contract, or certificate issued by a carrier; or</text>
        </paragraph>
        <paragraph num="(xii)">
          <text>If offered as a separate insurance policy, Medicare supplemental health insurance, as defined in §1882(g)(1) of the Social Security Act, coverage supplemental to the coverage provided under Chapter 55 of Title 10 of the United States Code, or similar supplemental coverage provided under an employer sponsored plan.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“HEDIS” means the Healthcare Effectiveness Data and Information Set published by the National Committee for Quality Assurance.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Measurement year” means the calendar year in which services take place and that precedes the reporting period in which the quality and performance measures report is submitted to the Commission or its contractor.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Performance measures report” means the report that a carrier submits to the Commission or its contractor that includes the performance measures calculated in accordance with the HEDIS and other applicable performance measure specifications.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Proprietary information” means information that would put a carrier at a competitive disadvantage if such information were disclosed.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Quality and performance evaluation system” means the process by which the Commission carries out its responsibilities related to the evaluation and reporting of quality and performance of health benefit plans.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Reporting period” means the year in which a carrier submits HEDIS and other performance measures to the Commission or its contractor and which follows the measurement year.</text>
    </paragraph>
  </paragraph>
</regulation>