31.17.02.02

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Carrier" means:

(a) An authorized insurer that provides health insurance in the State;

(b) A nonprofit health service plan that is licensed to operate in the State; or

(c) A health maintenance organization that is licensed to operate in the State.

(2) "Medical or health condition" means any of the following:

(a) Acquired immunodeficiency syndrome (AIDS);

(b) Addison's disease;

(c) Amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease);

(d) Alzheimer's disease;

(e) Angina pectoris;

(f) Ankylosing Spondylitis;

(g) Anorexia;

(h) Aplastic anemia;

(i) Ascites;

(j) Banti's disease;

(k) Behavioral health in-patient treatment within the last 12 months;

(l) Bipolar disorder;

(m) Bulimia;

(n) Cancer treated or diagnosed within the last 5 years, except skin cancer;

(o) Cardiomyopathy;

(p) Chemical dependency;

(q) Chronic obstructive pulmonary disease;

(r) Cirrhosis of the liver;

(s) Coronary artery disease;

(t) Coronary heart failure;

(u) Coronary insufficiency;

(v) Coronary occlusion;

(w) Creutzfeldt-Jakob disease;

(x) Crohn's disease;

(y) Cystic fibrosis;

(z) Dementia;

(aa) Type I or II diabetes;

(bb) Disorders from organic brain damage;

(cc) Emphysema;

(dd) Esophageal varices;

(ee) Friederich's ataxia;

(ff) Guillain-Barré syndrome;

(gg) Hemochromatosis;

(hh) Hemophilia;

(ii) Hepatitis B or C;

(jj) Hodgkin's disease;

(kk) Human immunodeficiency virus (HIV);

(ll) Huntington's chorea;

(mm) Hydrocephalus;

(nn) Kidney disease requiring dialysis;

(oo) Leukemia;

(pp) Lupus erythematosus disseminate;

(qq) Major organ transplant recipient;

(rr) Melanoma;

(ss) Multiple myeloma;

(tt) Multiple or disseminated sclerosis;

(uu) Muscular dystrophy;

(vv) Myasthenia gravis;

(ww) Myotonia;

(xx) Non-Hodgkin's lymphoma;

(yy) Palsy;

(zz) Paraplegia;

(aaa) Parkinson's disease;

(bbb) Pick's disease;

(ccc) Porphyria;

(ddd) Pregnancy;

(eee) Presence of a pacemaker;

(fff) Psychotic disorder;

(ggg) Quadriplegia;

(hhh) Rheumatoid arthritis;

(iii) Scleroderma;

(jjj) Sickle cell disease;

(kkk) Cerebrovascular accident (stroke);

(lll) Syringomyelia;

(mmm) Tay-Sachs disease;

(nnn) Ulcerative colitis;

(ooo) Wernicke-Kosakoff syndrome;

(ppp) Wilm's tumor; or

(qqq) Wilson's disease.

(3) Medically Uninsurable Individual.

(a) "Medically uninsurable individual" means an individual who is a resident of the State and who:

(i) Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual;

(ii) Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual, except at a rate that exceeds the Plan rate;

(iii) Is an eligible individual under Insurance Article, §15-1301, Annotated Code of Maryland;

(iv) Has a history of or suffers from a medical or health condition as defined in §B(2) of this regulation; or

(v) Is a dependent of an individual who is eligible for coverage under this subsection.

(b) "Medically uninsurable individual" does not include an individual who is eligible for coverage under:

(i) The federal Medicare program;

(ii) The Maryland Medical Assistance Program;

(iii) The Maryland Children's Health Program; or

(iv) An employer-sponsored group health insurance plan that includes benefits comparable to Plan benefits.

(4) "Plan" means the Maryland Health Insurance Plan.