24-A §3902. Definitions - Maine Statutes

Title 24-A: MAINE INSURANCE CODE

Chapter 54: MAINE INDIVIDUAL REINSURANCE ASSOCIATION

§3902. Definitions

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [2007, c. 629, Pt. A, §8 (NEW).]

1. Association. "Association" means the Maine Individual Reinsurance Association established in section 3903.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

2. Board. "Board" means the board of directors of the association.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

3. Health maintenance organization. "Health maintenance organization" means an organization authorized under chapter 56 to operate a health maintenance organization in this State.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

4. Insurer. "Insurer" means an entity that is authorized to write medical insurance or that provides medical insurance in this State. "Insurer" includes an insurance company, a nonprofit hospital and medical service organization, a fraternal benefit society, a health maintenance organization, a 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, a 3rd-party administrator, a multiple-employer welfare arrangement, any other entity providing medical insurance or health benefits subject to state insurance regulation, any reinsurer of health insurance in this State, the Dirigo Health Program established in chapter 87 or any other state-run or state-sponsored health benefit program, whether fully insured or self-funded.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

5. Medical insurance. "Medical insurance" means a hospital and medical expense-incurred policy, a nonprofit hospital and medical service plan, a health maintenance organization subscriber contract or other health care plan or arrangement that pays for or furnishes medical or health care services 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; or 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.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

6. 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.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

7. Member insurer. "Member insurer" means an insurer that offers individual medical insurance, is marketing an individual medical insurance policy in this State and has a medical-loss ratio of at least 70% in the individual insurance market.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

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

[ 2007, c. 629, Pt. A, §8 (NEW) .]

9. Reinsurer. "Reinsurer" means an insurer from whom a person providing health insurance for a resident procures insurance for itself with the insurer with respect to all or part of the medical insurance risk of the person. "Reinsurer" includes an insurer that provides employee benefits excess insurance.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

10. Resident. "Resident" has the same meaning as in section 2736-C, subsection 1, paragraph C-2.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

11. Third-party administrator. "Third-party administrator" means an entity that is paying or processing medical insurance claims for a resident.

[ 2007, c. 629, Pt. A, §8 (NEW) .]

SECTION HISTORY

2007, c. 629, Pt. A, §8 (NEW).