Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.32 - Nonprofit Health Service Plans-Material Modification
Section 31.10.32.02 - Definitions
Universal Citation: MD Code Reg 31.10.32.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Baltimore metro region" means Anne Arundel County, Baltimore City, Baltimore County, Carroll County, Harford County, and Howard County.
(2) "Cost-sharing arrangement" includes:
(a) A deductible;
(b) A co-insurance amount;
(c) A co-payment amount;
(d) An annual limit;
(e) A lifetime limit; and
(f) An out-of-pocket maximum.
(3) "DC metro region" means Montgomery County and Prince George's County.
(4) "Eastern Shore region" means Caroline County, Cecil County, Dorchester County, Kent County, Queen Anne's County, Somerset County, Talbot County, Wicomico County, and Worcester County.
(5) Health Benefit Plan.
(a) "Health benefit plan" means a hospital or medical policy, contract, or certificate issued by a nonprofit health service plan.
(b) "Health benefit plan" includes:
(i) A Medicare supplement policy, contract, or certificate;
(ii) A long-term care policy, contract, or certificate; or
(iii) A stop loss contract.
(6) "Health care provider" has the meaning stated in Insurance Article, §
14-101(b), Annotated Code of Maryland.
(7) "Key specialty" means:
(a) Cardiology;
(b) Dermatology;
(c) Family practice;
(d) Gastroenterology;
(e) Geriatrics;
(f) Internal medicine;
(g) Obstetrics/Gynecology (Ob/Gyn);
(h) Ophthalmology;
(i) Orthopedic surgery; or
(j) Pediatrics.
(8) "Market" means:
(a) The individual Medigap market;
(b) The individual non-Medigap market;
(c) The small-employer market governed by Insurance Article, Title 15, Subtitle 12, Annotated Code of Maryland; or
(d) The group market other than the small-employer market governed by Insurance Article, Title 15, Subtitle 12, Annotated Code of Maryland.
(9) "Nonprofit health service plan" means a corporation that:
(a) Holds a certificate of authority from the Commissioner to act as a nonprofit health service plan; and
(b) Has been assigned a National Association of Insurance Commissioners (NAIC) company code number.
(10) "Option" means a benefit or cost-sharing arrangement that:
(a) Is available in a health benefit plan; and
(b) If chosen, would alter the cost of the health benefit plan.
(11) "Product" means a category of one or more health benefits plans sold by a nonprofit health service plan in a particular market.
(12) "Southern Maryland region" means Calvert County, Charles County, and St. Mary's County.
(13) "Western Maryland region" means Allegany County, Frederick County, Garrett County, and Washington County.
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