North Dakota Code 26.1-36.7-01 – Definitions
For purposes of this chapter, unless the context otherwise requires:
Terms Used In North Dakota Code 26.1-36.7-01
- Contract: A legal written agreement that becomes binding when signed.
- following: when used by way of reference to a chapter or other part of a statute means the next preceding or next following chapter or other part. See North Dakota Code 1-01-49
- Individual: means a human being. See North Dakota Code 1-01-49
- Organization: includes a foreign or domestic association, business trust, corporation, enterprise, estate, joint venture, limited liability company, limited liability partnership, limited partnership, partnership, trust, or any legal or commercial entity. See North Dakota Code 1-01-49
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- United States: includes the District of Columbia and the territories. See North Dakota Code 1-01-49
1. “Association” means the reinsurance association of North Dakota.
2. “Board” means the board of directors of the reinsurance association of North Dakota.
3. “Earned group health benefit plan premiums” means premium owed to an insurer for a period of time during which the insurer has been liable to cover claims for an insured pursuant to the terms of a group health benefit plan issued by the insurer.
4. “Future losses” means reserves for claims incurred but not reported.
5. “Group health benefit plan” means a health benefit plan offered through an employer, or an association of employers, to more than one individual employee.
6. “Health benefit plan” means any hospital and medical expense-incurred policy or certificate, nonprofit health care service plan contract, health maintenance organization subscriber contract, or any other health care plan or arrangement that pays for or furnishes benefits that pay the costs of or provide medical, surgical, or hospital care.
a. “Health benefit plan” does not include any one or more of the following:
(1) Coverage only for accident or disability income insurance, or any combination of the two; (2) Coverage issued as a supplement to liability insurance; (3) Liability insurance, including general liability insurance and automobile liability insurance; (4) Workforce safety and insurance or similar workers’ compensation insurance; (5) Automobile medical payment insurance; (6) Credit-only insurance; (7) Coverage for onsite medical clinics; (8) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits; and
(9) Self-funded plans.
b. “Health benefit plan” does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:
(1) Limited scope dental or vision benefits; (2) Benefits for long-term care, nursing home care, home health care, or community-based care, or any combination of this care; and
(3) Other similar limited benefits specified under federal regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 [Pub. L. 104-191; 110 Stat. 1936; 29 U.S.C. § 1181 et seq.].
c. “Health benefit plan” does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance; there is no coordination between the provision of the benefits; and any exclusion of benefits under any group health insurance coverage maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same sponsor:
(1) Coverage only for specified disease or illness; and
(2) Hospital indemnity or other fixed indemnity insurance.
d. “Health benefit plan” does not include the following if offered as a separate policy, certificate, or contract of insurance:
(1) Medicare supplement health insurance as defined under section 1882(g)(1) of the federal Social Security Act [42 U.S.C. § 13295ss(g)(1)]; (2) Coverage supplemental to the coverage provided under chapter 55 of United States Code title 10 [10 U.S.C. § 1071 et seq.] relating to armed forces medical and dental care; and
(3) Similar supplemental coverage provided under a group health plan.
7. “Individual health benefit plan” means a health benefit plan offered to individuals, other than in connection with a group health benefit plan. The term does not include an individual short-term limited-duration plan or association short-term limited-duration plan as defined by section 26.1-36.8-01.
8. “Insured” means an individual who is insured by a health benefit plan.
9. “Insurer” means an entity authorized to write health benefit plans or that provides health benefit plans in the state. The term includes an insurance company as defined in section 26.1-02-01, a nonprofit health service organization, a fraternal benefit society, and a health maintenance organization.
10. “Member insurer” means an insurer that offers individual health benefit plans and is actively marketing individual health benefit plans in this state.