§ 27-8-8-2 — Definitions

Indiana § 27-8-8-2

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 8: Indiana Life and Health Insurance Guaranty Association

Text

(a) The definitions in this section apply
throughout this chapter.
(b) "Account" means one (1) of the two (2) accounts created under
section 3 of this chapter.
(c) "Annuity contract", except as provided in section 2.3(e) of this
chapter, includes:
(1) a guaranteed investment contract;
(2) a deposit administration contract;
(3) a structured settlement annuity;
(4) an annuity issued to or in connection with a government
lottery; and
(5) an immediate or a deferred annuity contract.
(d) "Assessment base year" means, for an impaired insurer or
insolvent insurer, the most recent calendar year for which required
premium information is available preceding the calendar year during
which the impaired insurer's or insolvent insurer's coverage date
occurs.
(e) "Association", except when the context otherwise requires,
means the Indiana life and health insurance guaranty association
created by section 3 of this chapter.
(f) "Benefit plan" means a specific plan, fund, or program that is
established or maintained by an employer or an employee organization,
or both, that:
(1) provides retirement income to employees; or
(2) results in a deferral of income by employees for a period
extending to or beyond the termination of employment.
(g) "Board" refers to the board of directors of the association
selected under IC 27-8-8-4.
(h) "Called", when used in the context of assessments, means that
notice has been issued by the association to member insurers requiring
the member insurers to pay, within a time frame set forth in the notice,
an assessment that has been authorized by the board.
(i) "Commissioner" refers to the insurance commissioner appointed
under IC 27-1-1-2.
(j) "Contractual obligation" means an enforceable obligation under
a covered policy for which and to the extent that coverage is provided
under section 2.3 of this chapter.
(k) "Coverage date" means, with respect to a member insurer, the
date on which the earlier of the following occurs:
(1) The member insurer becomes an insolvent insurer.
(2) The association determines that the association will provide
coverage under section 5(a) of this chapter with respect to the
member insurer.
(l) "Covered policy" means a:
(1) nongroup policy or contract;
(2) certificate under a group policy or contract; or
(3) part of a policy, contract, or certificate described in
subdivisions (1) and (2);
for which coverage is provided under section 2.3 of this chapter.
(m) "Extracontractual claims" includes claims that relate to bad faith
in the payment of claims, punitive or exemplary damages, or attorney's
fees and costs.
(n) "Funding agreement" has the meaning set forth in IC 27-1-12.7-1.
(o) "Health benefit plan" means a hospital or medical expense
policy or certificate, a health maintenance organization subscriber
contract or certificate, or another similar health contract. The term does
not include the following:
(1) Accident only, credit, dental only, vision only, Medicare
supplement, or disability income insurance.
(2) Coverage for:
(A) long term care;
(B) home health care;
(C) community based care; or
(D) a combination of coverage specified in clauses (A) through
(C).
(3) Coverage for onsite medical clinics.
(4) Specified disease, hospital confinement indemnity, or limited
benefit health insurance if the types of coverage do not provide
coordination of benefits and are provided under separate policies,
contracts, or certificates.
(p) "Health care provider" means a health care provider that renders
health care services covered under a health insurance policy or contract
for which coverage is provided under section 2.3 of this chapter.
(q) "Impaired insurer" means a member insurer that is:
(1) not an insolvent insurer; and
(2) placed under an order of rehabilitation or conservation by a
court with jurisdiction.
(r) "Insolvent insurer" means a member insurer that is placed under
an order of liquidation with a finding of insolvency by a court with
jurisdiction.
(s) "Member insurer" means any person that holds a certificate of
authority to transact in Indiana any kind of insurance or health
maintenance organization business for which coverage is provided
under section 2.3 of this chapter. The term includes an insurer whose
certificate of authority to transact such insurance in Indiana may have
been suspended, revoked, not renewed, or voluntarily withdrawn but
does not include the following:
(1) A for-profit or nonprofit hospital or medical service
organization.
(2) A fraternal benefit society under IC 27-11.
(3) The Indiana Comprehensive Health Insurance Association or
any other mandatory state pooling plan or arrangement.
(4) An assessment company or another person that operates on an
assessment plan (as defined in IC 27-1-2-3(y)).
(5) An interinsurance or reciprocal exchange authorized by IC 27-6-6.
(6) A farm mutual insurance company under IC 27-5.1.
(7) A person operating as a Lloyds under IC 27-7-1.
(8) The political subdivision risk management fund established by
IC 27-1-29-10 and the political subdivision catastrophic liability
fund established by IC 27-1-29.1-7.
(9) A person similar to any person described in subdivisions (1)
through (8).
(t) "Moody's Corporate Bond Yield Average" means:
(1) the monthly average of the composite yield on seasoned
corporate bonds as published by Moody's Investors Service, Inc.;
or
(2) if the monthly average described in subdivision (1) is no
longer published, an alternative publication of interest rates or
yields determined appropriate by the association.
(u) "Multiple employer welfare arrangement" has the meaning set
forth in IC 27-1-34-1.
(v) "Owner" means the person:
(1) identified as the legal owner of a policy or contract according
to the terms of the policy or contract; or
(2) otherwise vested with legal title to a policy or contract through
a valid assignment completed in accordance with the terms of the
policy or contract and properly recorded as the owner on the
books of the insurer.
The term does not include a person with a mere beneficial interest in
a policy or contract.
(w) "Person" means an individual, a corporation, a limited liability
company, a partnership, an association, a governmental entity, a
voluntary organization, a trust, a trustee, or another business entity or
organization.
(x) "Plan sponsor" refers to only one (1) of the following with
respect to a benefit plan:
(1) The employer, in the case of a benefit plan established or
maintained by a single employer.
(2) The holding company or controlling affiliate, in the case of a
benefit plan established or maintained by affiliated companies
comprising a consolidated corporation.
(3) The employee organization, in the case of a benefit plan
established or maintained by an employee organization.
(4) In a case of a benefit plan established or maintained:
(A) by two (2) or more employers;
(B) by two (2) or more employee organizations; or
(C) jointly by one (1) or more employers and one (1) or more
employee organizations;
and that is not of a type described in subdivision (2), the
association, committee, joint board of trustees, or other similar
group of representatives of the parties that establish or maintain
the benefit plan.
(y) "Premiums" means amounts, deposits, and considerations
received on covered policies, less returned premiums, returned
deposits, returned considerations, dividends, and experience credits.
The term does not include the following:
(1) Amounts, deposits, and considerations received for policies or
contracts or parts of policies or contracts for which coverage is
not provided under section 2.3(d) of this chapter, as qualified by
section 2.3(e) of this chapter, except that an assessable premium
must not be reduced on account of the limitations set forth in
section 2.3(e)(3), 2.3(e)(15), or 2.3(f)(2) of this chapter.
(2) Premiums in excess of five million dollars ($5,000,000) on an
unallocated annuity contract not issued or not connected with a
governmental benefit plan established under Section 401, 403(b),
or 457 of the United States Internal Revenue Code.
(z) "Principal place of business" refers to the single state in which
individuals who establish policy for the direction, control, and
coordination of the operations of an entity as a whole primarily exercise
the direction, control, and coordination, as determined by the
association in the association's reasonable judgment by considering the
following factors:
(1) The state in which the primary executive and administrative
headquarters of the entity is located.
(2) The state in which the principal office of the chief executive
officer of the entity is located.
(3) The state in which the board of directors or similar governing
person of the entity conducts the majority of the board of
directors' or governing person's meetings.
(4) The state in which the executive or management committee of
the board of directors or similar governing person of the entity
conducts the majority of the committee's meetings.
(5) The state from which the management of the overall
operations of the entity is directed.
However, in the case of a plan sponsor, if more than fifty percent (50%)
of the participants in the plan sponsor's benefit plan are employed in a
single state, that state is considered to be the principal place of business
of the plan sponsor. The principal place of business of a plan sponsor
of a benefit plan described in subsection (x)(4), if more than fifty
percent (50%) of the participants in the plan sponsor's benefit plan are
not employed in a single state, is considered to be the principal place
of business of the association, committee, joint board of trustees, or
other similar group of representatives of the parties that establish or
maintain the benefit plan and, in the absence of a specific or clear
designation of a principal place of business, is considered to be the
principal place of business of the employer or employee organization
that has the largest investment in the benefit plan in question on the
coverage date.
(aa) "Receivership court" refers to the court in an insolvent insurer's
or impaired insurer's state that has jurisdiction over the conservation,
rehabilitation, or liquidation of the insolvent insurer or impaired
insurer.
(bb) "Resident" means the following:
(1) An individual who resides in Indiana on the applicable
coverage date.
(2) A person that is not an individual and has the person's
principal place of business in Indiana on the applicable coverage
date.
(cc) "State" includes a state, the District of Columbia, Puerto Rico,
and a United States possession, territory, or protectorate.
(dd) "Structured settlement annuity" means an annuity purchased to
fund periodic payments for a plaintiff or other claimant in payment for
or with respect to personal injury suffered by the plaintiff or other
claimant.
(ee) "Supplemental contract" means a written agreement entered
into for the distribution of proceeds under a life, health, or annuity
policy or contract.
(ff) "Unallocated annuity contract" means an annuity contract or
group annuity certificate:
(1) the owner of which is not a natural person; and
(2) that does not identify at least one (1) specific natural person
as an annuitant;
except to the extent of any annuity benefits guaranteed to a natural
person by an insurer under the contract or certificate. For purposes of
this chapter, an unallocated annuity contract shall not be considered a
group policy or group contract.
As added by Acts 1978, P.L.129, SEC.3. Amended by
P.L.8-1993, SEC.431; P.L.251-1995, SEC.20; P.L.129-2003, SEC.13;
P.L.193-2006, SEC.9; P.L.276-2013, SEC.31; P.L.208-2018, SEC.12;
P.L.286-2019, SEC.5.