2013 Maryland Code
§ 11-601 - Definitions

MD Ins Code § 11-601 (2013) What's This?


(a) In this subtitle the following words have the meanings indicated.

(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.

(c) “Contract holder” means a person to which a carrier has issued a 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.

(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.

Disclaimer: These codes 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.