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<regulation prefix="Regulation" num=".04" citation="COMAR 31.10.05.04" title_num="31" subtitle_num="10" chapter_num="05" heading="Definitions.">
  <paragraph num="A.">
    <text>Whenever used in this chapter or in a Medicare supplement policy subject to these regulations, or in any advertisement soliciting a Medicare supplement policy, the following terms shall have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Applicant” means, in the case of:</text>
      <paragraph num="(a)">
        <text>An individual Medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A group Medicare supplement policy or subscriber contract, the proposed certificate holder.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Certificate” means any certificate issued under a group Medicare supplement policy or contract which has been delivered or issued for delivery in this State, including any individual certificate issued by a nonprofit health service plan or by a health maintenance organization.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Direct response solicitation” means solicitation of individuals or groups through the mail or by mass media advertising, including both print and broadcast advertising.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Health care expenses” means expenses of health maintenance organizations associated with the delivery of health care services which are analogous to incurred losses of insurers. These expenses do not include:</text>
      <paragraph num="(a)">
        <text>Home office and overhead costs;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Advertising costs;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Commissions and other acquisition costs;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Taxes;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Capital costs;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Administrative costs; or</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Claims processing costs.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Health insurance” means insurance coverage as defined in Insurance Article, §1-101(q), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Individual policy” means:</text>
      <paragraph num="(a)">
        <text>Individually issued policies and certificates; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Certificates issued under group policies as a result of the direct response solicitation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Low-dose mammography” means X-ray examination of the breast using dedicated equipment including an X-ray tube, filter, compression device, screens, films, and cassettes specifically for mammography with average radiation exposure to deliver less than 1 rad mid-breast, two views per breast.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Medicaid” means the Maryland Medical Assistance Program or any similar program provided by the State in which the insured person resides.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Medicare” means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Medicare eligible expenses” means health care expenses of the kinds covered by Medicare to the extent these services are considered reasonable under Medicare rules and regulations.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Medicare Supplement Policy.</text>
      <paragraph num="(a)">
        <text>“Medicare supplement policy” means an individual or group policy, subscriber contract, or certificate of health insurance primarily designed, advertised, marketed, or otherwise purported to be a supplement to reimbursements under Medicare for the hospital, medical, surgical, nursing, or related expenses of persons eligible for Medicare by reason of age.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medicare supplement policy” does not include benefits offered by a health maintenance organization or other direct service organization in connection with a contract with the United States Health Care Financing Administration.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>“Medigap policy” means a Medicare supplement policy.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Policy and subscriber contracts”, whenever they appear in these regulations, include “certificate” unless the context indicates otherwise.</text>
    </paragraph>
  </paragraph>
</regulation>