Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.14 - Minimum Loss Ratio with Respect to Specified Disease Policies
Section 31.10.14.02 - Definitions
Universal Citation: MD Code Reg 31.10.14.02
Current through Register Vol. 51, No. 26, December 27, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Claim reserve" means the sum of the present value of amounts not yet due on claims plus the reserve for future contingent benefits included in Exhibit 9, Part B of the Annual Statement. All numerical references to the Annual Statement in this regulation are to the National Association of Insurance Commissioners form for Life and Accident and Health insurers, current edition.
(2) "Claims liability" means the amount included in Line 4a of Exhibit 11, Part 1 of the Annual Statement.
(3) "Loss ratio" means the ratio of losses incurred to premiums earned on specified disease policies.
(4) "Policy reserves" means the sum of the additional reserves plus the reserve for future contingent benefits included in Lines 2 and 3 of Exhibit 9, Part A of the Annual Statement.
(5) "Premium reserve" means unearned premiums plus advance premiums plus reserve for dividends, refunds, and retrospective rate credits.
(6) "Premiums written" means premiums due during the current year and is equal to premiums collected during the current year plus premiums uncollected at the end of the current year less premiums uncollected at the end of the previous year.
(7) Specified Disease Policy.
(a) "Specified disease policy" means a health insurance policy that provides:
(i) Benefits only for a disease or diseases specified in the policy or for treatment unique to a specified disease or diseases; or
(ii) Additional benefits for a disease or diseases specified in the policy or for treatment unique to a specified disease or diseases, provided the actuarial net premium for the additional benefits exceeds 33 percent of the actuarial net premium for all of the health insurance benefits provided in the policy.
(b) If an insurer issues a health insurance policy to which a rider providing coverage for a specified disease or diseases may be added at the option of the policy owner and if the actuarial net premium for the benefits provided by the rider exceeds 33 percent of the actuarial net premium for all of the health insurance benefits provided by the policy including the rider, then either the policy to which the rider is attached, or the rider separately, shall be considered to be a "specified disease policy", whichever the insurer elects.
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