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<regulation prefix="Regulation" num=".02" citation="COMAR 31.11.01.02" title_num="31" subtitle_num="11" chapter_num="01" 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 as defined in Insurance Article, §1-101, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nonprofit health service plan that is licensed to operate in Maryland.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Converted policy” means an individual policy or certificate issued to an individual in accordance with the requirements of this chapter upon termination of the individual's coverage under a group policy.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Expense Incurred.</text>
      <paragraph num="(a)">
        <text>“Expense incurred” means that the benefits payable under the contract are based on the medical expenses that the covered person incurs.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>For the purposes of this chapter, a contract that includes both expense-incurred benefits and indemnity benefits shall be considered to be written on an “expense-incurred” basis.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“Group health insurance policy” or “group policy” means either:</text>
      <paragraph num="(a)">
        <text>An insurance contract issued by an insurer under Insurance Article, §15-302, Annotated Code of Maryland, that insures employees or members, with or without their dependents, for hospital, surgical, medical, or major medical insurance on an expense-incurred basis; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A contract issued by a nonprofit health service plan to a group that insures employees or members, with or without their dependents, for hospital, medical, major medical, or surgical insurance on an expense-incurred basis.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Indemnity” means that the benefits payable under the contract are set amounts that are not related to the expenses the covered person incurs, such as a hospital indemnity policy that pays a flat fee for each day the covered person is confined in a hospital, regardless of the actual expenses the covered person incurs during the hospital confinement.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Insured person” means:</text>
      <paragraph num="(a)">
        <text>An employee, a member, or another certificate holder covered under the group policy; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Any eligible dependent of the employee, member, or certificate holder covered under the group policy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Medicare” means Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded.</text>
    </paragraph>
  </paragraph>
</regulation>