760 IAC 1-73-1 - Definitions

Authority: IC 27-16-4-7; IC 27-16-5-4; IC 27-16-5-6; IC 27-16-8-4

Affected: IC 27-16

Sec. 1.

The definitions set forth in IC 27-16 and the following definitions apply throughout this rule:

(1) "Fully insured" means a health benefit plan for which one hundred percent (100%) of the liability has been assumed by an insurance company or health maintenance organization authorized to conduct business in Indiana. The health benefit plan may include a layer of financial responsibility for claims assumed by the PEO as long as the insurance company or health maintenance organization is responsible for 100% of the PEO's liability in the event of nonpayment by the PEO. The covered individual must be entitled to make a claim for payment directly to the insurance company or health maintenance organization. A fully insured plan may have copay or deductible requirements as permitted by law.

(2) "Health benefit plan" means a plan that provides benefits for health care services. The term does not include the following:

(A) Accident only or disability income insurance or a combination thereof.

(B) Credit only insurance.

(C) Disability insurance.

(D) Coverage for a specified disease or illness.

(E) Medicare supplement policies.

(F) Long term care coverage.

(G) Workers' compensation insurance.

(H) Hospital indemnity of fixed indemnity insurance.

(I) Reinsurance contract issued on a stop loss, quota share, or similar basis.

(J) Short term major medical contracts.

(K) Liability insurance.

(L) Limited benefit coverage such as dental or vision only.

(3) "Qualified actuary" means an actuary that is a member of the American Academy of Actuaries and a Fellow in the Society of Actuaries.

Notes

760 IAC 1-73-1

Department of Insurance; 760 IAC 1-73-1; filed May 24, 2007, 4:15 p.m.: 20070620-IR-760060069FRA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA Readopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA