§ 27-20.4-3 - Definitions.
SECTION 27-20.4-3
§ 27-20.4-3 Definitions. – As used in this chapter, the following terms have the following meaning:
(1) "Director" means the director of the department ofbusiness regulation;
(2) "Individual contract" means any health benefit contractthat is not a group contract;
(3) "Insurer" means every medical service corporation,hospital service corporation, health maintenance organization licensed underchapter 41 of this title or as defined in § 42-62-4, or insurance companyoffering and/or insuring health services;
(4) "Late enrollee" means a person who requests enrollment ina group plan following the initial enrollment period provided under the termsof the plan, except that a person is not a late enrollee if:
(i) The request for enrollment is made within thirty (30)days after the termination of coverage under a prior contract or policy and theindividual did not request coverage initially under the succeeding contractbecause that individual was covered under a prior contract and coverage underthat contract ceased due to termination of employment, death of a spouse, ordivorce; or
(ii) A court has ordered that coverage be provided for aspouse or minor child under a covered employee's plan and the request forcoverage is made within thirty (30) days after issuance of the court order;
(5) "Prior contract" means the group or individual healthbenefit contract or health benefit plan that previously covered the person;
(6) "Replacement contract" means a total group health benefitcontract which replaces another total group health benefit contract;
(7) "Succeeding contract" means the group health benefitcontract under which the person is seeking coverage or a different healthbenefit plan under the same group health benefit contract; and
(8) "Total group contract" means a health benefit contractfor the coverage of all eligible members of the employer health plan.