§ 58-47-150. Definitions.

NORTH CAROLINA STATUTES AND CODES

Part 2. Third‑Party Administrators and Service Companies For Individual And GroupSelf‑insurers.

§ 58‑47‑150. Definitions.

As used in this Part:

(1) "Books andrecords" means all files, documents, and databases in a paper form,electronic medium, or both.

(2) "Self‑insurer"means a group of employers licensed by the Commissioner under Part 1 of thisArticle or a single employer licensed by the Commissioner under Article 5 ofChapter 97 of the General Statutes to retain its liability under the Workers'Compensation Act and to pay directly the compensation in the amount and mannerand when due as provided for in the Act.

(3) "Servicecompany" means an entity that has contracted with a self‑insurer forthe purpose of providing any services related to claims adjustment, losscontrol, or both.

(4) "Third‑partyadministrator" or "TPA" means a person engaged by a self‑insurerto execute the policies established by the self‑insurer and to provideday‑to‑day management of the self‑insurer. "Third‑PartyAdministrator" and "TPA" does not mean:

a. A self‑insureracting on behalf of its employees or the employees of one or more of itsaffiliates.

b. An insurer that islicensed under this Chapter or that is acting as an insurer with respect to apolicy lawfully issued and delivered by it and under the laws of a state inwhich the insurer is licensed to write insurance.

c. An agent or brokerwho is licensed by the Commissioner under Article 33 of this Chapter whoseactivities are limited exclusively to the sale of insurance.

d. An adjuster licensedby the Commissioner under Article 33 of this Chapter whose activities arelimited to adjustment of claims.

e. An individual who isan officer, a member, or an employee of a board.

(5) "Underwriting"means the process of selecting risks and classifying them according to theirdegrees of insurability so that the appropriate rates may be assigned. Theprocess also includes rejection of those risks that do not qualify. (1997‑362,s. 3.)