<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.11.03.02" title_num="31" subtitle_num="11" chapter_num="03" 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>“Applicable change in status” means the death of the insured.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Dependent child” means an individual who:</text>
      <paragraph num="(a)">
        <text>Is a child of the insured; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Either was covered under the group contract as a qualified or eligible dependent of the insured immediately preceding the applicable change in status, or was born to a qualified secondary beneficiary after the applicable change in status.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Employer” means an employer, an association of employers, or a trust sponsored by an employer or an association of employers to whom a group contract has been issued.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Expense-incurred basis” means that the:</text>
      <paragraph num="(a)">
        <text>Payment of benefits is based in whole or in part on the charge made by the provider; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Services are directly provided without additional charge except for any deductible or copayment specified in the policy;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Policies or contracts issued on an expense-incurred basis include but are not limited to:</text>
        <paragraph num="(i)">
          <text>Health maintenance organization coverage,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A policy which provides for the cost of a semiprivate hospital room,</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A policy which provides coverage for a semiprivate hospital room subject to a daily deductible,</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A policy which provides coverage for a semiprivate hospital room but which is subject to a copayment,</text>
        </paragraph>
        <paragraph num="(v)">
          <text>A policy which provides a daily hospital benefit of more than $100,</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>A policy which pays medical-surgical benefits on a usual and customary basis;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Following policies or contracts are not to be regarded as being on an expense-incurred basis:</text>
        <paragraph num="(i)">
          <text>A policy which provides a daily hospital benefit of a fixed dollar amount not in excess of $100 per day,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A policy which provides only medical-surgical benefits in accordance with a fixed schedule of fees.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Group policy” or “group contract” means an insurance contract issued or delivered in this State which provides hospital, surgical, medical, or major medical coverage issued to an employer for the benefit of its employees by:</text>
      <paragraph num="(a)">
        <text>An authorized insurer in accordance with Insurance Article, §15-302, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nonprofit health service plan authorized under Insurance Article, §§14-108—14-111, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A health maintenance organization authorized under Health-General Article, Title 19, Subtitle 7, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>“Insured” means an employee who is a resident of this State and covered under a group policy for a period of not less than 3 months.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Qualified secondary beneficiary” means, with respect to an insured, an individual other than the insured who is:</text>
      <paragraph num="(a)">
        <text>A beneficiary under the group contract as the spouse of the insured for at least the 30-day period immediately preceding an applicable change in status; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A dependent child.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>“Self-insured group health benefit program or plan” means a program or plan furnished by an employer for the benefit of its employees providing hospital, surgical, medical, or major medical benefits on an expense-incurred basis similar to benefits which could be provided under a group health insurance policy.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Termination statement” means a written notice of an event specified in Regulation .07 of this chapter provided to an employer on a form containing language prescribed by the Commissioner, or in substantially similar language, which is signed by the insured.</text>
    </paragraph>
  </paragraph>
</regulation>