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

2. B. Terms Defined.

   1. (1) “Carrier” means:

      1. (a) An authorized insurer that provides health insurance in the State;
      2. (b) A nonprofit health service plan that is licensed to operate in the State; or
      3. (c) A health maintenance organization that is licensed to operate in the State.

   2. (2) “Medical or health condition” means any of the following:

      1. (a) Acquired immunodeficiency syndrome (AIDS);
      2. (b) Addison's disease;
      3. (c) Amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease);
      4. (d) Alzheimer's disease;
      5. (e) Angina pectoris;
      6. (f) Ankylosing Spondylitis;
      7. (g) Anorexia;
      8. (h) Aplastic anemia;
      9. (i) Ascites;
      10. (j) Banti's disease;
      11. (k) Behavioral health in-patient treatment within the last 12 months;
      12. (l) Bipolar disorder;
      13. (m) Bulimia;
      14. (n) Cancer treated or diagnosed within the last 5 years, except skin cancer;
      15. (o) Cardiomyopathy;
      16. (p) Chemical dependency;
      17. (q) Chronic obstructive pulmonary disease;
      18. (r) Cirrhosis of the liver;
      19. (s) Coronary artery disease;
      20. (t) Coronary heart failure;
      21. (u) Coronary insufficiency;
      22. (v) Coronary occlusion;
      23. (w) Creutzfeldt-Jakob disease;
      24. (x) Crohn's disease;
      25. (y) Cystic fibrosis;
      26. (z) Dementia;
      27. (aa) Type I or II diabetes;
      28. (bb) Disorders from organic brain damage;
      29. (cc) Emphysema;
      30. (dd) Esophageal varices;
      31. (ee) Friederich's ataxia;
      32. (ff) Guillain-Barré syndrome;
      33. (gg) Hemochromatosis;
      34. (hh) Hemophilia;
      35. (ii) Hepatitis B or C;
      36. (jj) Hodgkin's disease;
      37. (kk) Human immunodeficiency virus (HIV);
      38. (ll) Huntington's chorea;
      39. (mm) Hydrocephalus;
      40. (nn) Kidney disease requiring dialysis;
      41. (oo) Leukemia;
      42. (pp) Lupus erythematosus disseminate;
      43. (qq) Major organ transplant recipient;
      44. (rr) Melanoma;
      45. (ss) Multiple myeloma;
      46. (tt) Multiple or disseminated sclerosis;
      47. (uu) Muscular dystrophy;
      48. (vv) Myasthenia gravis;
      49. (ww) Myotonia;
      50. (xx) Non-Hodgkin's lymphoma;
      51. (yy) Palsy;
      52. (zz) Paraplegia;
      53. (aaa) Parkinson's disease;
      54. (bbb) Pick's disease;
      55. (ccc) Porphyria;
      56. (ddd) Pregnancy;
      57. (eee) Presence of a pacemaker;
      58. (fff) Psychotic disorder;
      59. (ggg) Quadriplegia;
      60. (hhh) Rheumatoid arthritis;
      61. (iii) Scleroderma;
      62. (jjj) Sickle cell disease;
      63. (kkk) Cerebrovascular accident (stroke);
      64. (lll) Syringomyelia;
      65. (mmm) Tay-Sachs disease;
      66. (nnn) Ulcerative colitis;
      67. (ooo) Wernicke-Kosakoff syndrome;
      68. (ppp) Wilm's tumor; or
      69. (qqq) Wilson's disease.

   3. (3) Medically Uninsurable Individual.

      1. (a) “Medically uninsurable individual” means an individual who is a resident of the State and who:

         1. (i) Provides evidence that, for health reasons, a carrier has refused to issue substantially similar coverage to the individual;
         2. (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;
         3. (iii) Is an eligible individual under Insurance Article, §15-1301, Annotated Code of Maryland;
         4. (iv) Has a history of or suffers from a medical or health condition as defined in §B(2) of this regulation; or
         5. (v) Is a dependent of an individual who is eligible for coverage under this subsection.

      2. (b) “Medically uninsurable individual” does not include an individual who is eligible for coverage under:

         1. (i) The federal Medicare program;
         2. (ii) The Maryland Medical Assistance Program;
         3. (iii) The Maryland Children's Health Program; or
         4. (iv) An employer-sponsored group health insurance plan that includes benefits comparable to Plan benefits.
   4. (4) “Plan” means the Maryland Health Insurance Plan.

Authority: Insurance Article, §§14-501(h)(1)(iv) and 14-503(k), Annotated Code of Maryland

Effective date:

Regulations .01—.03 adopted as an emergency provision effective February 6, 2003 (30:5 Md. R. 365); adopted permanently effective August 4, 2003 (30:15 Md. R. 993)

Regulation .02B amended effective January 30, 2006 (33:2 Md. R. 85); May 5, 2008 (35:9 Md. R. 900); December 29, 2008 (35:26 Md. R. 2251)