N.D. Admin. Code 45-08-02-02
For purposes of this chapter:
1. "Carrier" means a person or an entity that offers or provides a policy, contract, or certificate of insurance coverage in this state. "Carrier" includes an insurer, a health maintenance organization, a nonprofit service corporation, or any other person or entity providing a policy, contract, or certificate of insurance coverage subject to state insurance regulation.
2. "Group-type basis" means a benefit plan, other than "salary budget" plans utilizing individual insurance policies, certificates, or subscriber contracts, which meets the following conditions:
a. Coverage is provided through insurance policies, certificates, or subscriber contracts to classes of employees or members defined in terms of conditions pertaining to employment or membership.
b. The coverage is not available to the general public and can be obtained and maintained only because of the covered person's membership in or connection with the particular organization or group, including bank depositor groups.
c. There are arrangements for bulk payment of premiums or subscription charges to the insurer or nonprofit service corporation.
d. There is sponsorship of the plan by the employer, union, bank, or association.
3.
a. "Health insurance coverage" means a hospital and medical expense incurred policy, a nonprofit health care service plan contract, a health maintenance organization subscriber contract, or any other health care plan or arrangement that pays for or furnishes medical or health care services whether by insurance or otherwise.
b. "Health insurance coverage" shall not include one or more, or any combination of, the following:
(1) Coverage only for accident, or disability income insurance, or any combination thereof;
(2) Coverage issued as a supplement to liability insurance;
(3) Liability insurance, including general liability insurance and automobile liability insurance;
(4) Workers' compensation or similar insurance;
(5) Automobile medical payment insurance;
(6) Credit-only insurance;
(7) Coverage for onsite medical clinics; and
(8) Other similar insurance coverage, specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) [ Pub. L. No. 104-191 ], under which benefits for medical care are secondary or incidental to other insurance benefits.
c. "Health insurance coverage" shall not include the following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the coverage:
(1) Limited scope dental or vision benefits;
(2) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; or
(3) Other similar, limited benefits specified in federal regulations issued pursuant to HIPAA.
d. "Health insurance coverage" shall not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:
(1) Coverage only for a specified disease or illness; or
(2) Hospital indemnity or other fixed indemnity insurance.
e. "Health insurance coverage" shall not include the following if offered as a separate policy, certificate, or contract of insurance:
(1) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act;
(2) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code; or
(3) Similar supplemental coverage provided to coverage under a group health plan.
N.D. Admin Code 45-08-02-02
General Authority: NDCC 26.1-04-08, 28-32-02
Law Implemented: NDCC 26.1-04-03(7), 26.1-30-19, 26.1-33-11, 26.1-33-12, 26.1-36-22, 26.1-36-23, 26.1-36-23.1