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Statutes Text

Article - Insurance




§11–601.

    (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.