Article - Insurance
(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 item; 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.