Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.07 - Required Standard Provisions
Section 31.12.07.02 - Definitions

Universal Citation: MD Code Reg 31.12.07.02

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) "Coverage period" means the interval of time the individual contract or group contract provides protection, in exchange for the payment of a particular premium.

(1-1) Group Contract.

(a) "Group contract" means a contractual agreement entered into between an HMO and an employer, union, trustee, association, or other organization for the provision of health care services on a prepaid basis to:
(i) Subscribers of the group contract holder; or

(ii) Subscribers of the group contract holder and the subscriber's dependents.

(b) "Group contract" includes a small employer health benefit plan as defined in Insurance Article, § 15-1201, Annotated Code of Maryland.

(2) "Group contract holder" means the entity to whom the group contract is issued.

(3) "HMO" means a health maintenance organization.

(4) "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 covering:
(a) The subscriber;

(b) The subscriber and the subscriber's dependents; or

(c) The subscriber's dependents.

(5) "Member" means an individual entitled to receive health care benefits from the HMO under an individual or group contract.

(6) "Subscriber" means for:
(a) Group contracts, the individual who is eligible to be covered under the contract, other than as a dependent, by reason of satisfying the eligibility requirements of the group contract; and

(b) Individual contracts, the individual to whom the HMO contract is issued.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.