<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.17.03.02" title_num="31" subtitle_num="17" 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>“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>“Commission” means the Health Services Cost Review Commission.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Creditable coverage” has the meaning stated in Insurance Article, §15-1301(f), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Date of adoption” means the earlier of:</text>
      <paragraph num="(a)">
        <text>A judicial decree of adoption; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The assumption of custody, pending adoption, of a prospective adoptive child by a prospective adoptive parent.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Employer sponsored plan” has the meaning stated in Insurance Article, §15-1301(h), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Fund” means the Maryland Health Insurance Plan Fund.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Grace period” means the period of 30 days following the due date of a premium, other than the first premium payable by an individual applying for coverage under the Plan, during which an individual may pay the premium to the Plan administrator and coverage continues under the Plan, without lapse.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Health benefit plan” has the meaning stated in Insurance Article, §15-1301(k), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Hospital” means each hospital in the State for which rates are established by the Commission.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Medically Uninsurable Individual.</text>
      <paragraph num="(a)">
        <text>“Medically uninsurable individual” means an individual who is a resident of the State and who:</text>
        <paragraph num="(i)">
          <text>Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual, except at a rate that exceeds the Plan rate;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Is an eligible individual under Insurance Article, §15-1301, Annotated Code of Maryland;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Has a history of or suffers from a medical or health condition under COMAR 31.17.02.02B(2);</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Is eligible for the tax credit for health insurance costs under §35 of the Internal Revenue Code; or</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Is a dependent of an individual who is a medically uninsurable individual under §B(12)(a)(i)—(v) of this regulation.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medically uninsurable individual” does not include an individual who is eligible for coverage under:</text>
        <paragraph num="(i)">
          <text>The federal Medicare program;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The Maryland Medical Assistance Program;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The Maryland Children's Health Program; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>An employer-sponsored group health insurance plan that includes benefits comparable to Plan benefits, unless the individual is eligible for the tax credit for health insurance costs under §35 of the Internal Revenue Code.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>“Member” means an individual covered under the Plan.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Plan” means the Maryland Health Insurance Plan.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Plan administrator” means the administrator selected by the Board to administer the Plan.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Preexisting Condition.</text>
      <paragraph num="(a)">
        <text>“Preexisting condition” means a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the date of enrollment for the Plan.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Preexisting condition” does not include pregnancy or congenital or birth defects of a newborn child.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(17)">
      <text>Substantially Similar Coverage.</text>
      <paragraph num="(a)">
        <text>“Substantially similar coverage” means coverage under 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>“Substantially similar coverage” 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>“Substantially similar coverage” 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 the health plan:</text>
        <paragraph num="(i)">
          <text>Limited scope dental or vision benefits;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Limited scope prescription drug benefits;</text>
        </paragraph>
        <paragraph num="(iii)">
          <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="(iv)">
          <text>Coverage only for a specified disease or illness; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Hospital indemnity or other fixed indemnity insurance.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>“Substantially similar coverage” does not include coverage listed under §B(17)(a) of this regulation if:</text>
        <paragraph num="(i)">
          <text>The carrier is willing to issue the coverage only with a waiver rider for a specific condition or conditions; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The coverage has annual out-of-pocket expenses for deductibles, co-payments, and other amounts, but not premiums, that exceed the amount of annual out-of-pocket expenses allowed for a high deductible plan as defined by §223(c)(2)(A) of the Internal Revenue Code, and as adjusted for inflation.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>