§ 24-A §1901 — Definitions

Maine § 24-A §1901

• Jurisdiction: Maine
• Title 24-A: MAINE INSURANCE CODE
• Ch. 18: INSURANCE ADMINISTRATORS

Text

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
1.
"Administrator" means any person who, on behalf of a plan sponsor, health care service plan, health maintenance organization or insurer, receives or collects charges, contributions or premiums for, or adjusts or settles claims on residents of this State in connection with any type of life, annuity, health, workers' compensation or employee benefit excess insurance benefit provided in or as an alternative to insurance as defined by sections 702 to 704, former Title 39 or Title 39‑A, other than any of the following:
2.
"ATF" means an administrator trust fund that is a special fiduciary account, established and maintained by an administrator under section 1909, in which contributions and premiums are deposited.
3.
"CASA" means a claims administration services account that is a special fiduciary account, established and maintained by an administrator under section 1909, from which claims and claims adjustment expenses are disbursed.
4.
"Charges" means any compensation paid by a plan sponsor, health care service plan, health maintenance organization or insurer for services performed by the administrator.
5.
"Contributions" means the value of funds that have been provided or are to be applied by a plan sponsor or other entity to fund the self-insured portion of any plan, or premiums charged to a plan sponsor or other entity by an insurer for coverage under contracts of insurance or excess insurance. Contributions include administrative fees charged to a covered individual. "Administrative fee" means any compensation paid by a covered individual for services performed by the administrator.
6.
"Covered individual" means any individual eligible for life, annuity, workers' compensation or health benefits under a plan.
7.
"Plan" means any plan, fund or program established or maintained by a plan sponsor, health care service plan, health maintenance organization or insurer to the extent that the plan, fund or program was established or is maintained to provide through insurance or alternatives to insurance any type of life, annuity, health or workers' compensation benefit within the scope of sections 702 to 704, former Title 39 or Title 39‑A.
8.
"Plan sponsor" means any person, other than an insurer, who establishes or maintains a plan covering residents of this State, including, but not limited to, plans established or maintained by 2 or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees or other similar group of representatives of the parties that establish or maintain the plan.
9.
"Premium" means any money charged a covered individual, plan sponsor or other entity to provide life, accident, workers' compensation or health insurance under a plan. The term "premium" includes amounts paid by or charged to a covered individual plan sponsor or other entity for stop loss or excess insurance.
10.
"Quasi-resident" means a nonresident licensee who receives or collects 50% or more of calendar year contributions, premium volume or other funds subject to administration from plan sponsors or insureds resident in this State.

Legislative History

PL 1989, c. 846, §§D2,E4 (NEW). PL 1991, c. 885, §§E25,26 (AMD). PL 1991, c. 885, §E47 (AFF). PL 1993, c. 702, §A10 (AMD). PL 1995, c. 673, §§A1,2 (AMD). PL 1997, c. 457, §28 (AMD). PL 1999, c. 609, §2 (AMD). PL 2003, c. 428, §C1 (AMD).