Conn. Agencies Regs. § 38a-272-3

Current through October 16, 2024

Section 38a-272-3 - Definitions

As used in Sections 38a-272-3 to 38a-272-10 inclusive:

(a) "Arrangement" means a fund, trust, plan, program or other mechanism by which a person provides, or attempts to provide, health care benefits to individuals.

(b) "Collectively bargained arrangement" means an arrangement which provides or represents that it is providing health care benefits or coverage under or pursuant to one or more collective bargaining agreements. "Collectively bargained arrangement" does not include an arrangement that is fully insured by a licensed insurer.

(c) "Commissioner" means the insurance commissioner of this state.

(d) "Employee leasing arrangement" means labor leasing, staff leasing, employee leasing, contract labor, extended employee staffing or supply, or other arrangements, under contract or otherwise, whereby one business or entity leases or obtains all or a significant number of its workers from another business or entity.

(e) "Employee welfare benefit plan" means any plan, fund or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care benefits, or benefits in the event of sickness, accident disability, death or unemployment.

(f) "Fully insured by a licensed insurer" means that, for all of the health care benefits or coverage provided or offered by or through an arrangement:

(1) A licensed insurer is directly obligated by contract to provide all of the coverage to or under the arrangement;

(2) The licensed insurer assumes all of the risk for payment of all covered services or benefits; and

(3) The liability of the licensed insurer for payment of the covered services or benefits runs directly to the individual employee, member or dependent receiving the health care services.

(g) "Licensed insurer" means an insurer, as defined in Section 38a-271 of the General Statutes, having a certificate of authority from the Commissioner to transact insurance in this state.

(h) "Producer" has the same meaning as provided in section 38a-702a of the Connecticut General Statutes.

(i) "Reportable MEWA" means a person that provides health care benefits or coverage to the employees of two or more employers. "Reportable MEWA" does not include:

(1) A licensed insurer;

(2) An arrangement which is fully insured by a licensed insurer;

(3) A collectively bargained arrangement;

(4) An employee welfare benefit plan established or maintained by a rural electric cooperative or a rural telephone cooperative; or

(5) An employee leasing arrangement.

(j) "Rural electric cooperative" means:

(1) Any organization which is exempt from tax under Section 501 (a) of Title 26 of the United States Code and which is engaged primarily in providing electric service on a mutual or cooperative basis; or

(2) Any organization described in Paragraph (4) or (6) of Section 501 (a) of Title 26 of the United States Code which is exempt from tax under Section 501 (a) of Title 26 and at least eighty percent (80%) of the members of which are organizations described in Paragraph (1) of this subsection.

(k) "Rural telephone cooperative" means an organization described in Paragraph (4) or (6) of Section 501 (c) of Title 26 of the United States Code which is exempt from tax under Section 501 (a) of Title 26 and at least eighty (80%) percent of the members of which are organizations engaged primarily in providing telephone service to rural areas of the United States on a mutual, cooperative or other basis.

Conn. Agencies Regs. § 38a-272-3

Effective September 25, 1992; Amended March 28, 1996; Amended September 9, 2013