LD 1168
pg. 7
Page 6 of 20 An Act To Reduce Individual Health Insurance Premiums Page 8 of 20
Download Bill Text
LR 790
Item 1

 
or furnishes medical or health care services, whether by insurance
or otherwise and 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 Part A and
Part 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.__Reinsurer.__"Reinsurer" means an insurer from whom a
person providing health insurance for a resident procures
insurance for itself with respect to all or part of the medical
insurance risk of the person.__"Reinsurer" includes an insurer
that provides employee benefit excess insurance.

 
12.__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 high-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.

 
13.__Third-party administrator.__"Third-party administrator"


Page 6 of 20 Top of Page Page 8 of 20