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<regulation prefix="Regulation" num=".02" citation="COMAR 31.14.02.02" title_num="31" subtitle_num="14" chapter_num="02" 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>“Employer group long-term care insurance” means a long-term care insurance policy that is:</text>
      <paragraph num="(a)">
        <text>Issued or delivered in Maryland to:</text>
        <paragraph num="(i)">
          <text>One or more employers or labor organizations; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A trust or the trustees of a fund established by one or more employers or labor organizations, or by a combination of employers or labor organizations; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Designed for:</text>
        <paragraph num="(i)">
          <text>Employees or former employees, or a combination of employees and former employees, of the employer or employers; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Members or former members, or a combination of members and former members, of the labor organization or labor organizations.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Exceptional increase” means only those increases filed by an insurer as exceptional for which the Commissioner determines that the need for a premium rate increase is justified due to:</text>
      <paragraph num="(a)">
        <text>Changes in laws or regulations applicable to long-term care coverage in the State; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Increased and unexpected utilization that affects the majority of insurers of similar products.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Incidental” means that the value of the long-term care benefits provided, as of the date of issue, is less than 10 percent of the total value of the benefits provided over the life of the policy.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Long-Term Care Insurance.</text>
      <paragraph num="(a)">
        <text>“Long-term care insurance” means any group or individual insurance policy, contract, certificate, or rider issued, delivered, or offered by an insurer that:</text>
        <paragraph num="(i)">
          <text>Is advertised, marketed, offered, or designed to provide coverage for not less than 24 consecutive months for covered persons on an expense incurred, indemnity, prepaid, or insured basis; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Provides one or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a situation other than an acute care unit of a hospital.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Long-term care insurance includes any product that is advertised, marketed, or offered as long-term care insurance.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>“Long-term care insurance” does not include any insurance policy, contract, certificate, or rider which is offered primarily to provide:</text>
        <paragraph num="(i)">
          <text>Basic Medicare supplement coverage;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Hospital confinement indemnity coverage;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Basic hospital expense or medical-surgical expense coverage;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Disability income protection coverage;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Accident-only coverage;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Specified disease or specified accident coverage; or</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Skilled nursing care.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>“Long-term care insurance” does not include benefits provided under any life insurance policy, contract, or rider:</text>
        <paragraph num="(i)">
          <text>That accelerates the death benefit specifically for one or more of the qualifying events of terminal illness, a medical condition requiring extraordinary medical intervention, permanent institutional confinement, or institutional confinement for a lengthy confinement;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>That provides the option of a lump-sum payment for one or more of the benefits in §B(4)(d)(i) of this regulation; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>In which neither benefits nor eligibility for benefits is conditioned on receipt of long-term care.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>“Long-term care insurance” does not include any certificate issued under an out-of-State employer group contract.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Loss ratio” means the ratio of losses incurred to premiums earned on policies issued, delivered, or renewed in the State.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Out-of-State employer group contract” means a group contract that is:</text>
      <paragraph num="(a)">
        <text>Entered into with an employer in a state other than Maryland; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Issued directly to an employer under the laws of that employer's state.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Policy” means any group or individual policy, contract, subscriber agreement, rider, certificate, or endorsement delivered or issued for delivery in the State by an insurer, a nonprofit health service plan, health maintenance organization, or a preferred provider organization.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Qualified actuary” means a member in good standing of the American Academy of Actuaries.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Similar Policy Forms.</text>
      <paragraph num="(a)">
        <text>“Similar policy forms” means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>With respect to certificates issued under employer group long-term care insurance policies, “similar policy forms” includes other certificates issued under employer group long-term care insurance policies with the same long-term care benefit classifications.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>With respect to certificates issued under employer group long-term care insurance policies, “similar policy forms” does not include certificates or policies issued as long-term care insurance, except those certificates described in §B(9)(b) of this regulation.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>For purposes of determining similar policy forms, long-term care policies and certificates shall be considered in the following three separate long-term care benefit classifications:</text>
        <paragraph num="(i)">
          <text>Institutional long-term care benefits only;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Noninstitutional long-term care benefits only; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Comprehensive long-term care benefits.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>