376.1075. Definitions.
Definitions.
376.1075. As used in sections 376.1075 to 376.1095, the following termsmean:
(1) "Administrator", "third-party administrator" or "TPA", a person whodirectly or indirectly solicits or effects coverage of, underwrites, collectscharges or premiums from, or adjusts or settles claims on residents of thisstate, or residents of another state from offices in this state, in connectionwith life or health insurance coverage, annuities, or workers' compensationexcept any of the following:
(a) An employer on behalf of its employees or the employees of one ormore subsidiary or affiliated corporations of such employer;
(b) A union on behalf of its members;
(c) An insurance company which is either licensed in this state pursuantto the requirements of this chapter or chapter 379, RSMo;
(d) An insurer authorized to do insurance business in another statepursuant to similar laws, with respect to a policy lawfully issued anddelivered in a state other than this state, when engaged in transacting thebusiness of insurance as defined by this chapter and chapter 379, RSMo;
(e) A health service corporation, health maintenance organization orprepaid dental plan operating pursuant to the requirements of chapter 354,RSMo, when engaged in its duties of providing health care or dental servicesand indemnifying its members;
(f) A life or health agent or broker licensed in this state, whoseactivities are limited exclusively to the sale of insurance;
(g) A creditor on behalf of its debtors with respect to insurancecovering a debt between the creditor and its debtors;
(h) A trust, its trustees, agents and employees acting thereunder,established in conformity with 29 U.S.C. 186;
(i) A trust exempt from taxation under Section 501(a) of the InternalRevenue Code, its trustees, and employees acting thereunder;
(j) A custodian, its agents and employees acting pursuant to a custodianaccount which meets the requirements of Section 401(f) of the Internal RevenueCode;
(k) A bank, credit union or other financial institution which is subjectto supervision or examination by federal or state banking authorities;
(l) A credit card issuing company which advances for and collectspremiums or charges from its credit card holders who have authorized it to doso, provided such company does not adjust or settle claims;
(m) A person who adjusts or settles claims in the normal course of hisor her practice or employment as an attorney at law, and who does not collectcharges or premiums in connection with life or health insurance coverage orannuities;
(n) An adjuster whose activities are limited to adjustment of claims andwho is either licensed by this state or working on behalf of a licensedworkers' compensation insurer;
(o) A person licensed as an insurance agent in this state, whoseactivities are limited exclusively to the activities of a managing generalagent;
(2) "Affiliate" or "affiliated", any entity or person who directly orindirectly through one or more intermediaries, controls or is controlled by,or is under common control with, a specified entity or person;
(3) "Control", as defined in chapter 382, RSMo;
(4) "Director", the director of the department of insurance, financialinstitutions and professional registration;
(5) "Insurance" or "insurance coverage", any coverage offered orprovided by an insurer;
(6) "Insurer", any person undertaking to provide life or healthinsurance coverage, annuities or workers' compensation coverage in this state. For the purposes of sections 376.1075 to 376.1095, insurer includes alicensed insurance company, a prepaid hospital or medical care plan, a healthmaintenance organization, a multiple employer self-insured health plan, aself-insured multiple employer welfare arrangement, or any other personproviding a plan of insurance subject to state insurance regulation. Insurerdoes not include a bona fide employee benefit plan established by an employeror an employee organization, or both, for which the insurance laws of thisstate are preempted pursuant to the Employee Retirement Income Security Act of1974;
(7) "Underwrites" or "underwriting" means, but is not limited to, theacceptance of employer or individual applications for coverage of individualsin accordance with the written rules of the insurer, the overall planning andcoordinating of an insurance program, and the ability to procure bonds andexcess insurance.
(L. 1993 H.B. 709 § 41, A.L. 1998 H.B. 1601, et al. merged with S.B. 852 & 913)Effective 8-28-98 (H.B. 1601, et al.) 1-1-99 (S.B. 852 & 913)