41-4002 DEFINITIONS.
INSURANCE
CHAPTER 40
SELF-FUNDED HEALTH CARE PLANS
41-4002. Definitions. For the purposes of this chapter unless context otherwise requires:
(1) "Administrator" is a person, if other than the trustee, appointed by the plan sponsor or employed by the trustee to provide administrative services to a self-funded plan.
(2) "Beneficiary" is any individual entitled, under the self-funded plan, to payment by the trust fund of any part of all of the cost of any health care service rendered him.
(3) "Claims liability" or "reserves" is the total of all incurred and unpaid claims, including incurred but not reported claims, for allowable benefits under a self-funded plan that are not reimbursed or reimbursable by stop-loss insurance provided by a carrier authorized to transact insurance in this state.
(4) "Contribution" is the amount paid or payable by the employer or employee into the trust fund.
(5) "Director" is the director of the department of insurance of this state.
(6) "Multiple employer welfare arrangement" shall have the same meaning as that given to such term by the employee retirement income security act of 1974.
(7) "Person" is any individual, corporation, association, firm, syndicate, organization, or other entity.
(8) "Plan sponsor" is any person who creates a plan for the benefit of any person.
(9) "Self-funded plan" or "plan" is any single or multiple employer welfare arrangement, or any other single or multiple employer plan, other than a plan providing only benefits under title 72, Idaho Code, under which payment for medical, surgical, hospital, and other services for prevention, diagnosis, or treatment of any disease, injury, or bodily condition of an employee is, or is to be, regularly provided for or promised from funds created or maintained in whole or in part by contributions or payments thereto by the employer or employers, or by the employer or employers and the employees, and not otherwise covered by insurance or contract with a health care service corporation or managed care organization authorized to transact business in this state.
(10) "Single employer" is any individual, sole proprietorship, business, partnership, corporation, limited liability company, firm or any other form of legally recognized entity or a group of two (2) or more employers under "common control" as defined in section 3(40)(B)(iii) of the employee retirement system act of 1974.
(11) "Surplus" is the excess of the assets of a self-funded plan minus the liabilities of the plan, provided the liabilities of a self-funded plan shall include the claims liability of the plan.
(12) "Trust fund" is a trust fund established in conjunction with a self-funded plan for receipt of contributions of employer and employees and payment of or with respect to health care service costs of beneficiaries.
(13) "Trustee" is the trustee, whether a single or multiple trustee, of the trust fund.