Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 04 - INSURERS › Chapter 31.04.19 - Filing of Forms Under File and Use Method › Section 31.04.19.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Accidental death policy" means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death of an insured.
(2) "Accidental death and dismemberment policy" means a health insurance policy that limits benefits under it to benefits that are payable upon the accidental death or dismemberment of an insured.
(3) "Administration" means the Maryland Insurance Administration.
(4) "Annuity" has the meaning defined in Insurance Article, §
										1-101, Annotated Code of Maryland.
(5) Application.
(a) "Application" means the form used to apply for insurance.
(b) "Application" includes:
(i) Group applications and enrollment forms; and
(ii) Individual applications.
(6) Blanket Health Insurance.
(a) "Blanket health insurance" has the meaning stated in Insurance Article, §
											15-305, Annotated Code of Maryland.
(b) "Blanket health insurance" does not include a contract or policy for which a covered individual is required to complete an application.
(7) "Commissioner" means the Maryland Insurance Commissioner.
(8) "Credit life insurance" has the meaning stated in Insurance Article, §
										13-101, Annotated Code of Maryland.
(9) Employer Retrospective Premium Arrangement.
(a) "Employer retrospective premium arrangement" means a rider to an employer group health insurance contract that provides that the employer may pay a negotiated reduced premium during the plan year, in accordance with a methodology approved by the Administration, with an adjustment at the end of the plan year based on the actual experience of the employer's group.
(b) "Employer retrospective premium arrangement" does not include any rider used with a small employer health benefit plan.
(10) Expense Incurred.
(a) "Expense incurred" means the benefits payable under the health insurance contract are based on the medical expenses the insured incurs.
(b) For the purposes of this chapter, a health insurance contract that includes both expense incurred benefits and indemnity benefits shall be considered to be written on an expense incurred basis.
(11) "File and use method" means the method prescribed by the Commissioner which permits an insurer to file forms prescribed in Regulation .05 of this chapter and begin using the form at the earlier of:
(a) 30 days after the date the forms are received by the Commissioner, provided the forms are not disapproved by the Commissioner within this 30 day period; or
(b) The date the insurer receives notice from the Commissioner that the filing has been accepted.
(12) "Final disposition" means approval, disapproval or withdrawal of a form submitted for approval.
(13) Form.
(a) "Form" means:
(i) A policy;
(ii) A certificate;
(iii) A contract;
(iv) A rider;
(v) An endorsement;
(vi) An amendment; or
(vii) An application.
(b) "Form" includes:
(i) An insert page to a contract, if the insurer complies with the insert page filing requirements for contractsS on an insert page basis found in COMAR 31.04.17.04B; and
(ii) A section of a contract, if the insurer complies with the section filing requirements for contracts on a sectional basis found in COMAR 31.04.17.04C.
(14) "Health benefit plan" has the meaning stated in Insurance Article, §
										15-1201, Annotated Code of Maryland.
(15) "Health insurance" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(16) "Indemnity" means the benefits payable under the health insurance contract are flat amounts that are not related to the expenses the insured incurs, such as a hospital indemnity contract that pays a flat fee for each day the insured is confined in a hospital regardless of the actual expenses the insured incurs during the hospital confinement.
(17) "Insurer" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(18) "Life insurance" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(19) "Long term care insurance" has the meaning stated in Insurance Article, §
										18-101, Annotated Code of Maryland.
(20) "Medical stop-loss insurance" has the meaning stated in Insurance Article, §
										15-129(a), Annotated Code of Maryland.
(21) "Medicare supplement policy" has the meaning stated in Insurance Article, §
										15-901, Annotated Code of Maryland.
(22) "Noncompliant" means a form is not in compliance with Maryland statutes and regulations.
(23) "Prior approval method" means the method that insurers use to file forms with the Commissioner in which the forms may not be used in Maryland by the insurer until the forms are approved by the Commissioner.
(24) "Small employer" has the meaning stated in Insurance Article, §
										31-101, Annotated Code of Maryland.
(25) "Wholesale life insurance" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.