<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.16.10.02" title_num="31" subtitle_num="16" chapter_num="10" 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>“Administration” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Carrier” means:</text>
      <paragraph num="(a)">
        <text>An insurer;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nonprofit health service plan;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A dental plan organization;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A fraternal benefit society;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A health maintenance organization; or</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The Maryland Automobile Insurance Fund (MAIF).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Commissioner” means the Insurance Commissioner of Maryland or the Insurance Commissioner’s designee.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Complainant” means a person who files a complaint with the Commissioner.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Complaint.</text>
      <paragraph num="(a)">
        <text>“Complaint” means any written communication received by the Commissioner that expresses dissatisfaction with a carrier.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Complaint” includes an oral communication received by the Commissioner, which is subsequently converted to a written form.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>“Complaint” does not include a dispute regarding a claim that is resolved by the Consumer Education and Advocacy Unit through the Rapid Response Program.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>“Complaint” includes a dispute that is initially handled by the Consumer Education and Advocacy Unit that is not resolved and is referred for a complaint investigation.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>“Complaint” does not include actions taken under Insurance Article, §27-1001, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>“Complaint” does not include a dispute that is subject to the authority of the Workers’ Compensation Commission.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>“Complaint investigation” means the process used by the Commissioner to determine if a carrier has violated a State statute, regulation, or order in its dealings or interactions with the complainant, to the extent the Commissioner has the authority to enforce that statute, regulation, or order.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Determination.</text>
      <paragraph num="(a)">
        <text>“Determination” means a decision by the Commissioner that requires the Commissioner to provide the opportunity for a hearing to a person aggrieved by the decision under Insurance Article, §2-210, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Determination” includes:</text>
        <paragraph num="(i)">
          <text>A decision as to whether a carrier against whom a complaint has been received violated a law, regulation, or order; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An order or notice issued under Insurance Article, §2-204, Annotated Code of Maryland.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>“Health care provider” means:</text>
      <paragraph num="(a)">
        <text>A hospital, as defined in Health-General Article, §19-301, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A person who is:</text>
        <paragraph num="(i)">
          <text>Licensed under Health Occupations Article, Annotated Code of Maryland, or similar laws of another state, to render health care services; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The treating provider of the individual who is entitled to coverage under a contract issued or delivered in Maryland by a carrier.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>“Market conduct action” has the meaning stated in COMAR 31.04.20.03.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Person” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Premium” has the meaning stated in Insurance Article, §1-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Rapid Response Program” means the process designed by the Administration to help Maryland residents resolve personal property and casualty insurance claims directly with the individual’s insurer.</text>
    </paragraph>
  </paragraph>
</regulation>