LD 1945
pg. 4
Page 3 of 18 An Act To Establish a High-risk Health Insurance Pool Page 5 of 18
Download Bill Text
LR 2814
Item 1

 
to write medical insurance or that provides medical insurance in
this State.__"Insurer" includes an insurance company, nonprofit
hospital and medical service organization, fraternal benefit
society, health maintenance organization, self-insurance
arrangement that provides health care benefits in this State to the
extent allowed under the federal Employee Retirement Income
Security Act of 1974, 3rd-party administrator, multiple-employer
welfare arrangement, any other entity providing medical insurance
or health benefits subject to state insurance regulation or any
reinsurer reissuing 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; and 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 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 established by
the board and subject to the approval of the superintendent
and not to exceed one year;

 
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


Page 3 of 18 Top of Page Page 5 of 18