<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.17.01.02" title_num="31" subtitle_num="17" 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>“Administrator” means:</text>
      <paragraph num="(a)">
        <text>A person that is registered as an Administrator under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A carrier.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Board” means the Board of Directors for the Maryland Health Insurance Plan.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Carrier” means:</text>
      <paragraph num="(a)">
        <text>An authorized insurer that provides health insurance in the State;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A nonprofit health service plan that is licensed to operate in the State; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A health maintenance organization that is licensed to operate in the State.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Health Plan.</text>
      <paragraph num="(a)">
        <text>“Health plan” means any:</text>
        <paragraph num="(i)">
          <text>Contract providing hospital, medical, or surgical benefits on an expense incurred basis issued by an insurer;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Contract issued by a nonprofit health service plan;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Contract issued by a health maintenance organization; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Employer-sponsored plan that provides health benefits to the employees of the employer.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Health plan” does not include one or more, or any combination of the following:</text>
        <paragraph num="(i)">
          <text>Coverage only for accident or disability insurance;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Coverage issued as a supplement to liability insurance;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Coverage only for travel insurance;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Liability insurance, including general liability insurance and automobile liability insurance;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Workers' compensation or similar insurance;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Automobile medical payment insurance;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Credit-only insurance; or</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Coverage for on-site medical clinics.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>“Health plan” does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of a plan:</text>
        <paragraph num="(i)">
          <text>Limited scope dental or vision benefits;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Benefits for long-term care, nursing home care, home health care, community based care, or any combination of these benefits;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Coverage only for a specified disease or illness; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Hospital indemnity or other fixed indemnity insurance.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>“Health plan” does not include the following benefits if offered as a separate insurance policy:</text>
        <paragraph num="(i)">
          <text>Medicare supplemental health insurance, as defined under §1882(g)(1) of the Social Security Act;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Coverage supplemental to the coverage provided under 10 U.S.C. Chapter 55; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Coverage that is similar to the supplemental coverage described in §B(4)(d)(i) and (ii) of this regulation, which is provided as supplemental coverage under an employer sponsored plan.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Managed care organization” has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Member” means an individual covered under the Plan.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Plan” means the Maryland Health Insurance Plan.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Plan Administrator” means the Administrator selected by the Board to administer the Plan.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Private review agent” has the meaning stated in Insurance Article, §15-10B-01(k), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Utilization review” means a system for reviewing the appropriate and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients.</text>
    </paragraph>
  </paragraph>
</regulation>