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Statutes Text

Article - Insurance




§18–101.

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

    (b)    “Alzheimer’s disease” means a progressive brain disease diagnosed as Alzheimer’s disease by the licensed attending physician of the insured or certificate holder and confirmed by a second opinion of a licensed physician.

    (c)    “Applicant” means:

        (1)    for an individual policy or contract of long-term care insurance, the individual who seeks to contract for benefits; or

        (2)    for a group policy of long-term care insurance, the proposed certificate holder.

    (d)    “Carrier” means an insurer, nonprofit health service plan, health maintenance organization, or preferred provider organization.

    (e)    “Certificate” means a certificate that is issued under a group policy of long-term care insurance if the certificate is delivered or issued for delivery in the State and covers individuals who reside in the State.

    (f)    (1)    “Long-term care insurance” means an individual or group policy, contract, certificate, or rider that:

            (i)    is issued, delivered, or offered by a carrier;

            (ii)    is advertised, marketed, offered, or designed to provide coverage for at least 24 consecutive months for each covered individual on an expense-incurred, indemnity, prepaid, or insured basis; and

            (iii)    provides one or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital.

        (2)    “Long-term care insurance” includes any product that is advertised, marketed, or offered as long-term care insurance.

        (3)    “Long-term care insurance” does not include:

            (i)    a policy, contract, certificate, or rider that is offered primarily to provide:

                1.    basic Medicare supplement coverage;

                2.    hospital confinement indemnity coverage;

                3.    basic hospital expense or medical surgical expense coverage;

                4.    disability income protection coverage;

                5.    accident-only coverage;

                6.    specified disease or specified accident coverage; or

                7.    skilled nursing care;

            (ii)    a life insurance policy that:

                1.    accelerates the death benefit specifically for:

                A.    one or more of the qualifying events of terminal illness;

                B.    a medical condition that requires extraordinary medical intervention; or

                C.    permanent institutional confinement;

                2.    provides the option of lump-sum payments for the benefits listed in item 1 of this subparagraph; or

                3.    does not make benefits or eligibility for benefits conditional on receipt of long-term care; or

            (iii)    a certificate that is issued under an out-of-state employer group contract.

    (g)    “Loss ratio” means the ratio of losses incurred to premiums earned on policies that are issued, delivered, or renewed in the State.

    (h)    “Out-of-state employer group contract” means a group contract that:

        (1)    is entered into with an employer in a state other than this State; and

        (2)    is issued directly to an employer under the laws of that employer’s state.

    (i)    “Preexisting condition” means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within 6 months before the effective date of coverage of the insured or certificate holder.