<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.10.42.02" title_num="31" subtitle_num="10" chapter_num="42" 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:</text>
      <paragraph num="(a)">
        <text>An insurer authorized to sell health insurance;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nonprofit health service plan;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A health maintenance organization;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A dental plan organization; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Any other entity providing a plan of health insurance, health benefits, or health services authorized under the Insurance Article of the Annotated Code of Maryland or the Affordable Care Act.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Enrollee” means a:</text>
      <paragraph num="(a)">
        <text>Person entitled to health care benefits from a carrier; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Program recipient who is enrolled in a managed care organization.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Health benefit plan” has the meaning stated in Insurance Article, §15-140, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Managed care organization” means:</text>
      <paragraph num="(a)">
        <text>A certified health maintenance organization that is authorized to receive medical assistance prepaid capitation payments;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A corporation that:</text>
        <paragraph num="(i)">
          <text>Is a managed care system that is authorized to receive medical assistance prepaid capitation payments;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Enrolls only Program recipients or individuals or families served under the Maryland Children’s Health Program; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Is subject to the requirements of Health-General Article, §15-102.4, Annotated Code of Maryland.; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A prepaid dental plan that receives fees to manage dental services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Program recipient” means an individual who receives benefits under the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Receiving carrier” means the carrier that issues the new health benefit plan when an enrollee transitions from another carrier or a managed care organization.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Receiving managed care organization” means the managed care organization that accepts the enrollee when the enrollee transitions from another managed care organization or a carrier.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Relinquishing carrier” means a carrier that issued the prior health benefit plan when an enrollee transitions to a new carrier or a managed care organization.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Relinquishing managed care organization” means a managed care organization in which an enrollee had been enrolled prior to the enrollee’s transition to a new managed care organization or a carrier.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Transitioning enrollee” means an enrollee:</text>
      <paragraph num="(a)">
        <text>Who has an effective date of coverage with a receiving carrier or a receiving managed care organization on or after January 1, 2015, under a contract that is issued or renewed on or after January 1, 2015; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Whose coverage under the receiving carrier or receiving managed care organization began within 1 month of the date coverage terminated under the:</text>
        <paragraph num="(i)">
          <text>Health benefit plan with a relinquishing carrier; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Relinquishing managed care organization.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>