For purposes of this chapter, unless the context otherwise requires:
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,
Free access — add to your briefcase to read the full text and ask questions with AI
For purposes of this chapter, unless the context otherwise requires:
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.