LD 394
pg. 7
Page 6 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 8 of 21
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LR 516
Item 1

 
another entity providing medical insurance or health benefits
subject to state insurance regulation and a reinsurer that
reinsures health insurance in this State.

 
7.__Medical insurance.__"Medical insurance" means a hospital
and medical expense-incurred policy, nonprofit hospital and
medical service plan, health maintenance organization subscriber
contract or other health care plan or arrangement that pays for
or furnishes medical or health care services whether by insurance
or otherwise, whether sold as an individual or group policy.
"Medical insurance" does not include accidental injury, specified
disease, hospital indemnity, dental, vision, disability income,
Medicare supplement, long-term care or other limited benefit
health insurance or credit insurance; coverage issued as a
supplement to liability insurance; insurance arising out of
workers' compensation or similar law; automobile medical payment
insurance; or insurance under which benefits are payable with or
without regard to fault and that is statutorily required to be
contained in any liability insurance policy or equivalent self-
insurance.

 
8.__Medicare.__"Medicare" means coverage under both Parts A
and B of Title XVIII of the federal Social Security Act, 42
United States Code, Section 1395 et seq., as amended.

 
9.__Plan.__"Plan" means the health insurance plan adopted by
the board pursuant to this chapter.

 
10.__Producer.__"Producer" means a person who is licensed to
sell health insurance in this State.

 
11.__Resident.__"Resident" means an individual who:

 
A.__Is legally located in the United States and has been
legally domiciled in this State for a period to be
established by the board, not to exceed one year, subject to
the approval of the superintendent;

 
B.__Is legally domiciled in this State on the date of
application to the plan and is eligible for enrollment in
the risk pool under this chapter as a result of the federal
Health Insurance Portability and Accountability Act of 1996;
or

 
C.__Is legally domiciled in this State on the date of
application to the plan and has been certified as eligible
for federal trade adjustment assistance or for pension
benefit guarantee corporation assistance, as provided by the
federal Trade Adjustment Assistance Reform Act of 2002.


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