§ 26-42-102 — Definitions

Wyoming § 26-42-102

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 42: WYOMING LIFE AND HEALTH INSURANCE

Text

(a) As used in this act:
(i) "Account" means any of the three (3) accounts
created by W.S. 26-42-104(a);
(ii) "Association" means the Wyoming life and health
insurance guaranty association created by W.S. 26-42-104;
(iii) "Authorized assessment" or the term
"authorized" when used in the context of assessments means a
resolution by the board of directors has been passed whereby an
assessment will be called immediately or in the future from
member insurers for a specified amount. An assessment is
authorized when the resolution is passed;
(iv) "Benefit plan" means a specific employee, union
or association of natural persons benefit plan;
(v) "Called assessment" or the term "called" when
used in the context of assessments means that a notice has been
issued by the association to member insurers requiring that an
authorized assessment be paid within the time frame set forth
within the notice. An authorized assessment becomes a called
assessment when notice is mailed by the association to member
insurers;
(vi) "Contractual obligation" means any obligation
under a policy or contract or certificate under a group policy
or contract, or portion thereof for which coverage is provided
under W.S. 26-42-103;
(vii) "Covered policy" or "covered contract" means
any policy or contract or portion of a policy or contract for
which coverage is provided by W.S. 26-42-103;
(viii) "Extra-contractual claims" shall include
claims relating to bad faith in the payment of claims, punitive
or exemplary damages or attorneys' fees and costs;
(ix) "Impaired insurer" means a member insurer which
is not an insolvent insurer and is placed under an order of
rehabilitation or conservation by a court of competent
jurisdiction;
(x) "Insolvent insurer" means a member insurer which
after the effective date of this act, is placed under an order
of liquidation by a court of competent jurisdiction with a
finding of insolvency;
(xi) "Member insurer" means any insurer or health
maintenance organization which is licensed or holds a
certificate of authority to transact in this state any kind of
insurance or health maintenance organization business for which
coverage is provided by W.S. 26-42-103 and includes any insurer
or health maintenance organization business whose license or
certificate of authority in this state may have been suspended,
revoked, not renewed or voluntarily withdrawn, but does not
include:
(A) Repealed By Laws 1997, ch. 125, § 1.
(B) Repealed by Laws 1995, ch. 210, § 5.
(C) A fraternal benefit society;
(D) A mandatory state pooling plan;
(E) A stipulated premium insurance company;
(F) A local mutual burial association;
(G) A mutual assessment company or any entity
that operates on an assessment basis;
(H) An insurance exchange; or
(J) Any entity similar to any of the above.
(xii) "Moody's Corporate Bond Yield Average" means
the Monthly Average Corporates as published by Moody's Investors
Service, Inc., or any successor thereto;
(xiii) "Owner" of a policy or contract, "contract
owner", "policyholder" and "policy owner" mean the person who is
identified as the legal owner under the terms of the policy or
contract or who is otherwise vested with legal title to the
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 member insurer. The
terms "owner", "contract owner", "policyholder" and "policy
owner" do not include persons with a mere beneficial interest in
a policy or contract;
(xiv) "Plan sponsor" means:
(A) The employer in the case of a benefit plan
established or maintained by a single employer;
(B) The employee organization in the case of a
benefit plan established or maintained by an employee
organization; or
(C) In a case of a benefit plan established or
maintained by two (2) or more employers or jointly by one (1) or
more employers and one (1) or more employee organizations, the
association, committee, joint board of trustees or other similar
group of representatives of the parties who establish or
maintain the benefit plan.
(xv) "Premiums" means amounts received on covered
policies or contracts less premiums, considerations and deposits
returned thereon, and less dividends and experience credits
thereon, but does not include any amounts received for any
policies or contracts or for the portions of any policies or
contracts for which coverage is not provided by W.S. 26-42-
103(b) except that assessable premium shall not be reduced due
to W.S. 26-42-103(c)(iii) relating to interest limitations and
W.S. 26-42-103(d)(ii) relating to limitations with respect to
any one (1) individual, one (1) participant and one (1) policy
owner or contract owner. "Premiums" shall not include:
(A) Premiums on an unallocated annuity contract;
or
(B) With respect to multiple nongroup policies
of life insurance owned by one (1) owner, whether the policy
owner or contract owner is an individual, firm, corporation or
other person, and whether the persons insured are officers,
managers, employees or other persons, premiums in excess of five
million dollars ($5,000,000.00) with respect to these policies
or contracts, regardless of the number of policies or contracts
held by the owner.
(xvi) "Principal place of business" of:
(A) A plan sponsor or a person other than a
natural person means the single state in which the natural
persons who establish policy for the direction, control and
coordination of the operations of the entity as a whole
primarily exercise that function, determined by the association
in its reasonable judgment by considering the following factors:
(I) The state in which the primary
executive and administrative headquarters of the entity is
located;
(II) The state in which the principal
office of the chief executive officer of the entity is located;
(III) The state in which the board of
directors, or similar governing person or persons, of the entity
conducts the majority of its meetings;
(IV) The state in which the executive or
management committee of the board of directors, or similar
governing person or persons, of the entity conducts the majority
of its meetings;
(V) The state from which the management of
the overall operations of the entity is directed; and
(VI) In the case of a benefit plan
sponsored by affiliated companies comprising a consolidated
corporation, the state in which the holding company or
controlling affiliate has its principal place of business as
determined using the above factors. However, in the case of a
plan sponsor, if more than fifty percent (50%) of the
participants in the benefit plan are employed in a single state,
that state shall be deemed the principal place of business for
the plan sponsor.
(B) A plan sponsor of a benefit plan shall be
deemed to be the principal place of business of the association,
committee, joint board of trustees or other similar group of
representatives of the parties who establish or maintain the
benefit plan that, in lieu of a specific or clear designation of
a principal place of business, shall be deemed to be the
principal place of business or the employer or employee
organization that has the largest investment in the benefit plan
in question.
(xvii) "Receivership court" means the court in the
insolvent or impaired insurer's state having jurisdiction over
the conservation, rehabilitation or liquidation of the member
insurer;
(xviii) "Resident" means a person to whom a
contractual obligation is owed and who resides in this state on
the date of entry of a court order that determines a member
insurer to be an impaired insurer or a court order that
determines a member insurer to be an insolvent insurer. A person
may be a resident of only one (1) state, which in the case of a
person other than a natural person is its principal place of
business. Citizens of the United States who are either residents
of foreign countries or residents of United States possessions,
territories or protectorates that do not have an association
similar to the association created by this act, shall be deemed
residents of the state of domicile of the member insurer that
issued the policies or contracts;
(xix) "Structured settlement annuity" means an
annuity purchased in order 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;
(xx) "Supplemental contract" means a written
agreement entered into for the distribution of proceeds under a
life, health or annuity policy or life, health or annuity
contract;
(xxi) "Unallocated annuity contract" means an annuity
contract or group annuity certificate which is not issued to and
owned by an individual, except to the extent of any annuity
benefits guaranteed to an individual by an insurer under the
contract or certificate;
(xxii) "Enrollee" means an individual who is enrolled
in a health maintenance organization;
(xxiii) "Health benefit plan" means any hospital or
medical expense policy or certificate, or health maintenance
organization subscriber contract or any other similar health
contract. "Health benefit plan" does not include any of the
following:
(A) Accident only insurance;
(B) Credit insurance;
(C) Dental only insurance;
(D) Vision only insurance;
(E) Medicare supplement insurance;
(F) Benefits for long term care, home health
care, community based care or any combination thereof;
(G) Disability income insurance;
(H) Coverage for on-site medical clinics;
(J) Specified disease, hospital confinement
indemnity or limited benefit health issuance if the types of
coverage do not provide coordination of benefits and are
provided under separate policies or certificates.
(xxiv) "This act" means W.S. 26-42-101 through 26-42-
118.