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§ 11-601. Definitions

West's Annotated Code of MarylandInsuranceEffective: July 1, 2012

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 11. Insurance Rating Law
Subtitle 6. Health Benefit Plan Premium Rate Review (Refs & Annos)
Effective: July 1, 2012
MD Code, Insurance, § 11-601
§ 11-601. Definitions
In general
(a) In this subtitle the following words have the meanings indicated.
Carrier
(b) “Carrier” means a person that:
(1) offers a health benefit plan in the State; and
(2) is:
(i) an insurer;
(ii) a nonprofit health service plan; or
(iii) a health maintenance organization.
Contract holder
(c) “Contract holder” means a person to which a carrier has issued a health benefit plan.
Health benefit plan
(d)(1) “Health benefit plan” means:
(i) a health insurance contract, a nonprofit health service plan contract, or a health maintenance organization contract that includes benefits for medical care; or
(ii) a certificate of health insurance issued or delivered to a Maryland resident under a contract issued to an association located in the State or any other state.
(2) “Health benefit plan” does not include:
(i) one or more, or any combination of the following:
1. coverage only for accident or disability income insurance;
2. coverage issued as a supplement to liability insurance;
3. liability insurance, including general liability insurance and automobile liability insurance;
4. workers' compensation or similar insurance;
5. automobile medical payment insurance;
6. credit-only insurance;
7. coverage for on-site medical clinics; and
8. other similar insurance coverage, as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits;
(ii) 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 health benefit plan:
1. limited scope dental or vision benefits;
2. benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these benefits; and
3. other similar limited benefits as specified in federal regulations issued pursuant to P.L. 104-191;
(iii) the following benefits if offered as independent, noncoordinated benefits:
1. coverage only for a specified disease or illness; and
2. hospital indemnity or other fixed indemnity insurance; or
(iv) the following benefits if offered as a separate policy, certificate, or contract of insurance:
1. Medicare supplemental health insurance, as defined in § 1882(g)(1) of the Social Security Act;
2. coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and
3. similar supplemental coverage provided to coverage under an employer sponsored plan.
Medical care
(e) “Medical care” means:
(1) items or services for the diagnosis, cure, mitigation, treatment, or prevention of a disease, injury, or condition affecting any structure or function of the body; and
(2) transportation primarily for and essential to medical care described in item (1) of this subsection.

Credits

Added by Acts 2012, c. 513, § 1, eff. July 1, 2012; Acts 2012, c. 514, § 1, eff. July 1, 2012.
MD Code, Insurance, § 11-601, MD INSURANCE § 11-601
Current through all legislation from the 2022 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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