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<regulation prefix="Regulation" num=".02" citation="COMAR 31.10.06.02" title_num="31" subtitle_num="10" chapter_num="06" 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>“Adverse decision” has the meaning stated in Insurance Article, §15-10A-01, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Applicant” means:</text>
      <paragraph num="(a)">
        <text>In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the case of a group Medicare supplement policy, the proposed certificate holder.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Bankruptcy” means when a Medicare Advantage organization that is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the State.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Certificate” means any certificate delivered or issued for delivery in this State under a group Medicare supplement policy.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Certificate form” means the form on which the certificate is delivered or issued for delivery by the issuer.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Complaint” means any dissatisfaction expressed by an individual concerning a Medicare Select issuer or its network providers.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Continuous period of creditable coverage” means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than 63 days.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Coverage decision” has the meaning stated in Insurance Article, §15-10D-01, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Creditable coverage.</text>
      <paragraph num="(a)">
        <text>“Creditable coverage” means, with respect to an individual, coverage of the individual provided under any of the following:</text>
        <paragraph num="(i)">
          <text>A group health plan;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Health insurance coverage;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Part A or Part B of Title XVIII of the Social Security Act (Medicare);</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under §1928;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Chapter 55 of Title 10 United States Code (CHAMPUS);</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>A medical care program of the Indian Health Service or of a tribal organization;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>A State health benefits risk pool;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>A health plan offered under Chapter 89 of Title 5 United States Code (Federal Employees Health Benefits Program);</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>A public health plan as defined in federal regulation; and</text>
        </paragraph>
        <paragraph num="(x)">
          <text>A health benefit plan under §5(e) of the Peace Corps Act (22 U.S.C. §2504(e)).</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Creditable coverage” does not include one or more, or any combination of, the following:</text>
        <paragraph num="(i)">
          <text>Coverage only for accident or disability income insurance, or any combination of them;</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 medical payment insurance;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Credit-only insurance;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Coverage for on-site medical clinics; and</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>“Creditable coverage” does not include coverage for 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 of coverage described in §B(9)(a) of this regulation:</text>
        <paragraph num="(i)">
          <text>Limited scope dental or vision benefits;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these coverages; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Other similar, limited benefits as are specified in federal regulations.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>“Creditable coverage” does not include coverage for the following benefits if offered as independent, noncoordinated benefits:</text>
        <paragraph num="(i)">
          <text>Coverage only for a specified disease or illness; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Hospital indemnity or other fixed indemnity insurance.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>“Creditable coverage” does not include the following coverage if it is offered as a separate policy, certificate, or contract of insurance:</text>
        <paragraph num="(i)">
          <text>Medicare supplemental health insurance as defined under §1882(g)(1) of the Social Security Act;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Similar supplemental coverage provided to coverage under a group health plan.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>“Employee welfare benefit plan” means a plan, fund, or program of employee benefits as defined in 29 U.S.C. §1002 (Employee Retirement Income Security Act).</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Grievance” means dissatisfaction expressed in writing by an individual insured under a Medicare Select policy or certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its network providers.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Insolvency” means when an issuer, licensed to transact the business of insurance in this State, has had a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Issuer” means insurance companies, fraternal benefit societies, nonprofit health service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this State Medicare supplement policies or certificates.</text>
    </paragraph>
    <paragraph num="(14)">
      <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="(15)">
      <text>Medicare Advantage Plan.</text>
      <paragraph num="(a)">
        <text>“Medicare Advantage plan” means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. §1395w-28(b)(1).</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medicare Advantage plan” includes:</text>
        <paragraph num="(i)">
          <text>Coordinated care plans that provide health care services, including health maintenance organization plans (with or without a point-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Medical savings account plans coupled with a contribution into a Medicare Advantage Plan medical savings account; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Medicare Advantage private fee-for-service plans.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(16)">
      <text>“Medicare Select certificate” means a Medicare supplement certificate that contains restricted network provisions.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Medicare Select issuer” means an issuer offering, or seeking to offer, a Medicare Select policy or certificate.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Medicare Select policy” means a Medicare supplement policy that contains restricted network provisions.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>Medicare Supplement Policy.</text>
      <paragraph num="(a)">
        <text>“Medicare supplement policy” means a group or individual policy of health insurance, or a certificate of a fraternal benefit society, or a subscriber contract of a nonprofit health service plan or of a health maintenance organization, other than a policy issued pursuant to a contract under the federal Social Security Act, §1876, or an issued policy under a demonstration project specified in 42 U.S.C. §1395ss(g)(1), which is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of persons eligible for Medicare.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medicare supplement policy” does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under §1833(a)(1)(A) of the Social Security Act.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(20)">
      <text>“Network provider” means a provider, or group of providers, of health care which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.</text>
    </paragraph>
    <paragraph num="(21)">
      <text>“Newly eligible for Medicare” means the individual:</text>
      <paragraph num="(a)">
        <text>Attained age 65; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Became entitled to benefits under part A pursuant to §226(b) or 226A of the Social Security Act, or is deemed to be eligible for benefits under §226(a) of the Social Security Act.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(22)">
      <text>1990 standardized Medicare Supplement Benefit Plan.</text>
      <paragraph num="(a)">
        <text>“1990 standardized Medicare supplement benefit plan”, “1990 standardized benefit plan”, or “1990 plan” means a group or individual policy of Medicare supplement insurance issued on or after July 14, 1992, and with an effective date for coverage before June 1, 2010.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“1990 standardized Medicare supplement benefit plan”, “1990 standardized benefit plan”, or “1990 plan” includes Medicare supplement insurance policies and certificates described in §B(21)(a) of this regulation that are renewed on or after June 1, 2010, which are not replaced by the issuer at the request of the insured.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(23)">
      <text>“Policy form” means the form on which the policy or certificate is delivered or issued for delivery by the issuer.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Restricted network provision” means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Secretary” means the Secretary of the United States Department of Health and Human Services.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Service area” means the geographic area approved by the Secretary of the Maryland Department of Health within which an issuer is authorized to offer a Medicare Select policy.</text>
    </paragraph>
    <paragraph num="(27)">
      <text>“2010 standardized Medicare supplement benefit plan”, “2010 standardized benefit plan”, or “2010 plan” means a group or individual policy of Medicare supplement insurance issued with an effective date for coverage on or after June 1, 2010.</text>
    </paragraph>
  </paragraph>
</regulation>