26.1-08 Comprehensive Health Association
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<![CDATA[CHAPTER 26.1-08COMPREHENSIVE HEALTH ASSOCIATION26.1-08-01. Definitions. In this chapter, unless the context otherwise requires:1."Association" means the comprehensive health association of North Dakota.2."Benefit plan" means insurance policy coverage offered by the association through<br>the lead carrier.3."Benefit plan premium" means the charge for the benefit plan based on the benefits<br>provided in section 26.1-08-06 and determined pursuant to section 26.1-08-08.4."Board" means the association board of directors.5."Church plan" means a plan as defined under section 3(33) of the federal Employee<br>Retirement Income Security Act of 1974.6."Creditable coverage" has the same meaning as "qualifying previous coverage" as<br>defined under section 26.1-36.3-01.7."Eligible individual" means an individual eligible for association benefit plan coverage<br>as specified under section 26.1-08-12.8."Governmental plan" has the same meaning as provided under section 3(32) of the<br>federal Employee Retirement Income Security Act of 1974 [Pub. L. 93-406; 88 Stat.<br>833; 29 U.S.C. 1002] and as may be provided under any federal governmental plan.9."Group health plan" has the same meaning as employee welfare benefit plan as<br>provided under section 3(1) of the federal Employee Retirement Income Security Act<br>of 1974 [Pub. L. 93-406; 88 Stat. 833; 29 U.S.C. 1002] to the extent that the plan<br>provides medical care, and including items and service paid for as medical care to<br>employees or the employees' dependents as defined under the terms of the plan<br>directly or through insurance, reimbursement, or otherwise.10."Health insurance coverage" means any hospital and medical expense-incurred<br>policy, nonprofit health care service plan contract, health maintenance organization<br>subscriber contract, or any other health care plan or arrangement that pays for or<br>furnishes benefits that pay the costs of or provide medical, surgical, or hospital care<br>or, if selected by the eligible individual, chiropractic care.a.Health insurance coverage does not include any one or more of the following:(1)Coverage only for accident, disability income insurance, or any<br>combination of the two;(2)Coverage issued as a supplement to liability insurance;(3)Liability insurance, including general liability insurance and automobile<br>liability insurance;(4)Workforce safety and insurance or similar insurance;(5)Automobile medical payment insurance;(6)Credit-only insurance;(7)Coverage for onsite medical clinics; andPage No. 1(8)Other similar insurance coverage, specified in federal regulations, under<br>which benefits for medical care are secondary or incidental to other<br>insurance benefits.b.Health insurance coverage does not include the following benefits if they are<br>provided under a separate policy, certificate, or contract of insurance or are<br>otherwise not an integral part of the plan:(1)Limited scope dental or vision benefits;(2)Benefits for long-term care, nursing home care, home health care,<br>community-based care, or any combination of this care; and(3)Other similar limited benefits specified under federal regulations issued<br>under the Health Insurance Portability and Accountability Act of 1996<br>[Pub. L. 104-191; 110 Stat. 1936; 29 U.S.C. 1181 et seq.].c.Health insurance coverage does not include any of the following benefits if the<br>benefits are provided under a separate policy, certificate, or contract of<br>insurance; there is no coordination between the provision of the benefits; any<br>exclusion of benefits under any group health insurance coverage maintained by<br>the same plan sponsor; and the benefits are paid with respect to an event<br>without regard to whether benefits are provided with respect to such an event<br>under any group health plan maintained by the same sponsor:(1)Coverage only for specified disease or illness; and(2)Hospital indemnity or other fixed indemnity insurance.d.Health insurance coverage does not include the following if offered as a<br>separate policy, certificate, or contract of insurance:(1)Coverage supplemental to the coverage provided under chapter 55 of<br>United States Code title 10 [10 U.S.C. 1071 et seq.] relating to armed<br>forces medical and dental care; and(2)Similar supplemental coverage provided under a group health plan.11."Insurer" means any insurance company, nonprofit health service organization,<br>fraternal benefit society, health maintenance organization, and any other entity<br>providing or selling health insurance coverage or health benefits that are subject to<br>state insurance regulation.12."Lead carrier" means the insurance company selected by the board to administer<br>the association benefit plans.13."Medicare" means coverage under both parts A and B of title XVIII of the federal<br>Social Security Act [Pub. L. 89-97; 79 Stat. 291; 42 U.S.C. 1395 et seq.].14."Participating member" means any insurer that is licensed in this state which has an<br>annual earned premium volume of health insurance coverage, including medicare<br>supplemental health insurances as defined under section 1882(g)(1) of the federal<br>Social Security Act [42 U.S.C. 1395ss(g)(1)], derived from or on behalf of residents<br>in the previous calendar year of at least one hundred thousand dollars.15."Resident" means an individual who has been a legal resident of this state for a<br>minimum of one hundred eighty-three days, determined by applying section<br>54-01-26.However, for a federally defined eligible individual as defined undersubdivision b of subsection 5 of section 26.1-08-12, there is no minimum residencyPage No. 2requirement. The board may waive the residency requirement upon a showing of<br>good cause.16."Significant break in coverage" means a period of sixty-three or more consecutive<br>days during all of which the individual does not have creditable coverage. Neither a<br>waiting period nor an affiliation period is taken into account in determining a<br>significant break in coverage.17."Trade adjustment assistance, pension benefit guarantee corporation individual"<br>means an individual who is certified as eligible for federal trade adjustment<br>assistance or federal pension benefit guarantee corporation assistance as provided<br>by the federal Trade Adjustment Assistance Reform Act of 2002 [Pub. L. 107-210;<br>116 Stat. 933], the spouse of such an individual, or a dependent of such an<br>individual as provided under the federal Internal Revenue Code.26.1-08-02. Duties of commissioner. Repealed by S.L. 2003, ch. 239, </p>
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