§ 31-101. Definitions
West's Annotated Code of MarylandInsuranceEffective: May 8, 2020
Effective: May 8, 2020
MD Code, Insurance, § 31-101
§ 31-101. Definitions
(a-1) “Application counselor” means an individual who holds an Individual Exchange application counselor certification issued under § 31-113(r) of this subtitle.
(a-2) “Application counselor sponsoring entity” or “sponsoring entity” means an entity designated by the Individual Exchange as a sponsoring entity under § 31-113(r) of this subtitle.
(b-1) “Captive producer” means an insurance producer who:
(c) “Carrier” means:
(c-1) “Consolidated Services Center” or “CSC” means the consumer assistance call center established in accordance with the requirement to operate a toll-free hotline under § 1311(d)(4) of the Affordable Care Act and § 31-108(b)(5) of this subtitle.
(d) “Coverage level” means a level of coverage, as defined in § 1302 of the Affordable Care Act and as determined in regulations adopted by the Secretary, for a qualified health plan.
(e)(1) “Exchange” means the Maryland Health Benefit Exchange established as a public corporation under § 31-102 of this subtitle.
(e-1)(1) “Full-time employee” means, with respect to a calendar month, an employee of a small employer who works, on average, at least 30 hours per week.
(f) “Fund” means the Maryland Health Benefit Exchange Fund established under § 31-107 of this subtitle.
(g)(1) “Health benefit plan” means a policy, contract, certificate, or agreement offered, issued, or delivered by a carrier to an individual or small employer in the State to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
(4) “Health benefit plan” does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether the benefits are provided under any group health plan maintained by the same plan sponsor:
2. a notice is displayed prominently in the application materials, in at least 14 point type, that has the following language in capital letters: “This is a supplement to health insurance and is not a substitute for major medical coverage. Lack of major medical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.”.
(h) “Health literacy” means the degree to which an individual has the capacity to obtain, process, and understand health information and services in order to make an appropriate health decision.
(i) “Individual Exchange” means the division of the Exchange that serves the individual health insurance market.
(j) “Individual Exchange connector entity” means a community-based organization or other entity or a partnership of entities that:
(k) “Individual Exchange connector entity authorization” means a grant of authority from the Individual Exchange to an Individual Exchange connector entity under § 31-113(f) of this subtitle.
(l) “Individual Exchange navigator” means an individual who:
(m) “Individual Exchange navigator certification” means a certificate issued by the Individual Exchange that authorizes an individual to act as an Individual Exchange navigator.
(n) “Insurance producer authorization” means a permit issued by the SHOP Exchange or Individual Exchange to allow an insurance producer to sell qualified plans in the SHOP Exchange or Individual Exchange.
(o) “Managed care organization” has the meaning stated in § 15-101 of the Health--General Article.
(p) “Maryland Health Care Reform Coordinating Council” means the joint executive-legislative council established and expanded by Executive Orders 01.01.2010.07 and 01.01.2011.10.
(p-1)(1) “Minimum essential coverage” means:
(q) “Qualified dental plan” means a dental plan certified by the Exchange that provides limited scope dental benefits, as described in § 31-108(b)(2) of this subtitle.
(r) “Qualified employer” means a small employer that elects to make its full-time employees and, at the option of the employer, some or all of its part-time employees eligible for one or more qualified health plans offered through the SHOP Exchange, provided that the employer:
(s) “Qualified health plan” means a health benefit plan that has been certified by the Exchange to meet the criteria for certification described in § 1311(c) of the Affordable Care Act and § 31-115 of this subtitle.
(t) “Qualified individual” means an individual, including a minor, who at the time of enrollment:
(u) “Qualified plan” means a:
(v) “Qualified vision plan” means a vision plan certified by the Exchange that provides limited scope vision benefits, as described in § 31-108(b)(3) of this subtitle.
(w) “Secretary” means the Secretary of the federal Department of Health and Human Services.
(x) “SHOP Exchange” means the Small Business Health Options Program authorized under § 31-108(b)(13) of this subtitle.
(y) “SHOP Exchange navigator” means an individual engaged by the SHOP Exchange and authorized by the Commissioner to provide the services described in § 31-112(c)(1) of this subtitle.
(z) “SHOP Exchange navigator license” means a license issued by the Commissioner that authorizes an individual to carry out the functions set forth in § 31-112(c) of this subtitle in the SHOP Exchange.
(aa)(1) “Small employer” means an employer that, during the preceding calendar year, employed an average of not more than 50 employees.
(v) an employer that makes enrollment in qualified health plans available to its employees through the SHOP Exchange, and would cease to be a small employer by reason of an increase in the number of its employees, shall continue to be treated as a small employer for purposes of this subtitle as long as it continuously makes enrollment through the SHOP Exchange available to its employees; and
(bb) “State benchmark plan” means the health benefit plan designated by the State, under regulations adopted by the Secretary, to serve as the standard for the essential health benefits to be offered by:
Credits
Added by Acts 2011, c. 1, § 1, eff. June 1, 2011; Acts 2011, c. 2, § 1, eff. June 1, 2011. Amended by Acts 2012, c. 66, § 1, eff. April 10, 2012; Acts 2012, c. 152, § 3, eff. June 1, 2012; Acts 2013, c. 159, § 2, eff. June 1, 2013; Acts 2013, c. 368, § 2, eff. Jan. 1, 2014; Acts 2015, c. 363, § 1, eff. May 12, 2015; Acts 2015, c. 22, § 5; Acts 2016, c. 8, § 1, eff. March 14, 2016; Acts 2017, c. 62, §§ 1 and 6, eff. April 11, 2017; Acts 2017, c. 720, § 1, eff. June 1, 2017; Acts 2018, c. 665, § 1, eff. Oct. 1, 2018; Acts 2019, c. 108, § 1, eff. Oct. 1, 2019; Acts 2019, c. 391, § 2, eff. July 1, 2019; Acts 2019, c. 423, § 1, eff. June 1, 2019; Acts 2019, c. 424, § 1, eff. June 1, 2019; Acts 2020, c. 628, § 1, eff. May 8, 2020.
MD Code, Insurance, § 31-101, MD INSURANCE § 31-101
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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