§ 26-43-101 — Definitions

(a) As used in this act:
(i) "Account" means the account provided by W.S.
26-43-112;
(ii) "Administrator" means the insurer, insurers or
third party administrator or administrators selected pursuant to
W.S. 26-43-104(a) to administer the pool;
(iii) "Board" means the board of directors of the
pool;
(iv) "Commissioner" means the insurance commissioner;
(v) "Department" means the insurance department;
(vi) "Health insurance" means any public health
benefit plan, private health benefit plan, hospital and medical
expense incurred policy, Medicare supplement policy, nonprofit
health care service plan contract and health maintenance
organization subscriber contract. The term does not include any
hospital or medical service plan which by contract or product
design is intended to provide coverage for six (6) months or
less, fixed indemnity, limited benefit or credit insurance,
coverage issued as a supplement to liability insurance,
insurance arising from a workers' compensation or similar law,
automobile medical payment insurance, or insurance under which
benefits are payable with or without regard to fault and which
is statutorily required to be contained in any liability
insurance policy or equivalent self-insurance;
(vii) "Health maintenance organization" means as
defined by W.S. 26-34-102;
(viii) "Hospital" means a facility licensed as a
hospital by the department of health;
(ix) "Insurance arrangement" means any plan, program,
contract or any other arrangement under which one (1) or more
employers, unions or other organizations provide to their
employees or members, either directly or indirectly through a
trust or third party administrator, health care services or
benefits other than through an insurer. For purposes of
assessments under this act "insurance arrangement" does not
include any plan, program, contract or other arrangement under
which the state of Wyoming, its political subdivisions or school
districts provide health care services or benefits pursuant to
the authority granted under W.S. 9-3-201;
(x) "Insured" means any individual resident of this
state who is eligible to receive benefits from any insurer or
insurance arrangement;
(xi) "Insurer" means any insurance company authorized
to transact disability insurance business in this state,
Medicare supplement insurance issuer, health maintenance
organization or health service plan operation under W.S. 26-22-
301;
(xii) "Medicare" means coverage under both Part A and
B of Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et
seq.;
(xiii) "Member" means all insurers and insurance
arrangements participating in the pool;
(xiv) "Plan of operation" means the plan of operation
of the pool, including articles, bylaws and operating rules
adopted by the board pursuant to W.S. 26-43-102;
(xv) "Pool" means the Wyoming health insurance pool
created by W.S. 26-43-102;
(xvi) Repealed by Laws 2019, ch. 16, § 2.
(xvii) "Creditable coverage" means, with respect to
an individual, coverage of the individual provided under any
private health benefit plan or public health benefit plan;
(xviii) "Federally defined eligible individual" means
an individual:
(A) For whom, as of the date on which the
individual seeks coverage under this act, the aggregate of the
periods of creditable coverage, is eighteen (18) or more months;
(B) Whose most recent prior creditable coverage
was under a group private or public health benefit plan;
(C) Who is not eligible for coverage under a
group health plan, part A or part B of Medicare or Medicaid, and
who does not have other health insurance coverage;
(D) With respect to whom the most recent
coverage within the period of aggregate creditable coverage was
not terminated based on a factor relating to nonpayment of
premiums or fraud;
(E) Who, if offered the option of continuation
coverage under a COBRA continuation provision or under a similar
state program, elected such coverage; and
(F) Who has exhausted such continuation coverage
under such provision or program, if the individual elected the
continuation coverage described in subparagraph (E) of this
paragraph.
(xix) "Eligibility level" means a percentage of the
federal poverty guideline for level of coverage under the plan
of operation;
(xx) "This act" means W.S. 26-43-101 through