Section 760 IAC 1-73-1 - DefinitionsAuthority: 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.(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. 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-760130479RFAReadopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA