§ 58-53-1. Definitions. - North Carolina Statutes

Article53.

Group Health InsuranceContinuation and Conversion Privileges.

Part 1.  Continuation.

§ 58‑53‑1. Definitions.

As used in this Article, thefollowing terms have the meanings specified:

(1)        "Grouppolicy" means a group accident and health insurance policy issued by aninsurance company and a group contract issued by a service corporation orhealth maintenance organization or similar corporation or organization.

(2)        "Individualpolicy" or "converted policy" means an individual healthinsurance policy issued by an insurance company or an individual contractissued by a service corporation or health maintenance organization or similarcorporation or organization.

(3)        "Insurance"and "insured" refer to coverage under a group policy, individualpolicy or converted policy on a premium‑paying basis, and do not includecoverage provided by reason of a disability extension.

(4)        "Insurer"means the entity issuing a group policy or an individual or converted policy.

(5)        "Medicare"means Title XVIII of the United States Social Security Act as added by theSocial Security Amendments of 1965 or as later amended or superseded.

(5a)      "Member" or"employee" includes an insured spouse or dependent of a member or ofan employee.

(6)        "Premium"includes any premium or other consideration payable for coverage under a groupor individual policy.

(7)        "Reasonable andcustomary" means the most frequently used level of charge made for thesupplies or for a specific service in the geographic subarea in which suchsupplies or services are received, of like kind or by physicians, or otherpractitioners, with similar qualifications. (1981, c. 706, s. 1; 1983, c.142, s. 1; 1997‑259, s. 10.)