Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.01 - Health Maintenance Organizations - Certificate of Authority and Fiscal Requirements
Section 31.12.01.02 - Definitions
Universal Citation: MD Code Reg 31.12.01.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. All terms defined in the Health Maintenance Organization Act of 1975 which are used in this chapter have the same meaning as in the Act unless the terms are defined differently in this chapter.
B. Terms Defined.
(1) "HMO" means a health maintenance organization.
(2) "Individual contract" means a contractual agreement for the provision of health care services on a prepaid basis entered into between an HMO and a subscriber, provided the contract covers only the following persons:
(a) The subscriber;
(b) The subscriber and the subscriber's dependents; or
(c) The subscriber's dependents.
(3) "Leasehold estate improvements" means improvements made to property which is leased by the HMO and used by it to provide health care directly.
(4) "Member" means the subscriber and any of the subscriber's dependents who are enrolled in the HMO.
(5) "Subscriber" means, for:
(a) Group HMO contracts, the person who is eligible to be covered under the contract, other than as a dependent, due to satisfaction of the eligibility requirements of the group; and
(b) Individual HMO contracts, the person who completes the application for coverage with the HMO.
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