Md. Code Regs. 31.12.07.02 - Definitions
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)
(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.
Notes
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