As used in this Section, the following terms have the following meanings:

(a) Co-payment is the partial payment of medical expenses, emergency room services, or prescription drugs required by an individual who is enrolled in a group health insurance plan. For example, a co-payment for a visit to a doctor’s office might be Ten Dollars ($10). Co-payments are in addition to the payment of premiums and deductible amounts.

(b) Deductible is the amount that must be paid by the insured out of pocket before benefits will be paid by the insurer.

(c) Pre-funded deductible is a deductible paid in increments during the plan year to the insurer by the insured from his or her post-tax dollars and held by the insurer to pay provided claims on behalf of the insured under the deductibles.

(d) Rebate or Refund is the amount of a payment that has been made or funded that is paid back, credited or otherwise returnable to a health insured that has completed a Wellness Program qualified under HIPAA.

(e) Premium is the payment, or one of the regular periodic payments, that a group employer and/or individual make to a health insurer to enroll in a health plan or to own an insurance policy.

SOURCE: GC § 54255. Amended by P.L. 22-14:1. R/R by P.L. 29-
121:2 (Dec. 2, 2008), effective, July 1, 2007, pursuant to P.L. 29-121:8.

§ 15707.1 Refunds, Rebates, Deductibles and Other Wellness
Incentives in Health Plans or Health Insurance Policies.

(a) It shall not be unlawful for an insurer to offer or sell, or for a broker, agent or solicitor on behalf of an insurer to offer or sell, a health plan or health insurance policy which provides for a refund or rebate of premium or deductible, a discounted co- payment or other wellness incentive in a health plan or health

22 Guam Code Ann. BUSINESS REGULATIONS
CH. 15 BUSINESS OF INSURANCE

insurance policy, provided, that any such valuable consideration or reward is specified in the plan or policy, and further provided, that the plan or policy complies with the Final Rules for Nondiscrimination and Wellness Programs promulgated under the Health Insurance Portability and Accountability Act of 1996 (“”HIPAA””), which provide an express exception to the general rule prohibiting discrimination on a health factor if the reward is based on participation in a wellness program of health promotion or disease prevention.

(b) It shall not be unlawful for an insurer to pay a refund or rebate of premium or refund a deductible to an insured or discount a co-payment under a health plan or health insurance policy, provided, that the amount of such payment complies with limitations and restrictions set forth in HIPAA and the Final Rules for Nondiscrimination and Wellness Programs promulgated under HIPAA.

(c) It is unlawful for any insurer or general agent to appoint an agent for the purpose of enabling such agent, or other person, to obtain at a cost less than that specified in the policy any insurance from such insurer.

(d) The provisions of this Section and the requirement of a wellness program under the exception to the HIPAA’s general rule against discrimination shall not be applicable to any health plan or health insurance policy which does not discriminate against any individual on any health factor or otherwise violate the general rule. Refunds of premiums, deductibles (including pre-funded deductibles) or co-payments which are uniformly applied to all similarly situated insureds are not rewards based on a health factor, and are therefore not in violation of the general rule.

SOURCE: Added by P.L. 29-121:3 (Dec. 2, 2008).