31A-29-103 - Definitions.
31A-29-103. Definitions.
As used in this chapter:
(1) "Board" means the board of directors of the pool created in Section 31A-29-104.
(2) (a) "Creditable coverage" has the same meaning as provided in Section 31A-1-301.
(b) "Creditable coverage" does not include a period of time in which there is a significantbreak in coverage, as defined in Section 31A-1-301.
(3) "Domicile" means the place where an individual has a fixed and permanent home andprincipal establishment:
(a) to which the individual, if absent, intends to return; and
(b) in which the individual, and the individual's family voluntarily reside, not for aspecial or temporary purpose, but with the intention of making a permanent home.
(4) "Enrollee" means an individual who has met the eligibility requirements of the pooland is covered by a pool policy under this chapter.
(5) "Health benefit plan":
(a) is defined in Section 31A-1-301; and
(b) does not include a plan that:
(i) (A) has a maximum actuarial value less that 100% of the basic health care plan; or
(B) has a maximum annual limit of $100,000 or less; and
(ii) meets other criteria established by the board.
(6) "Health care facility" means any entity providing health care services which islicensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act.
(7) "Health care insurance" is defined in Section 31A-1-301.
(8) "Health care provider" has the same meaning as provided in Section 78B-3-403.
(9) "Health care services" means:
(a) any service or product:
(i) used in furnishing to any individual medical care or hospitalization; or
(ii) incidental to furnishing medical care or hospitalization; and
(b) any other service or product furnished for the purpose of preventing, alleviating,curing, or healing human illness or injury.
(10) "Health maintenance organization" has the same meaning as provided in Section31A-8-101.
(11) "Health plan" means any arrangement by which an individual, including a dependentor spouse, covered or making application to be covered under the pool has:
(a) access to hospital and medical benefits or reimbursement including group orindividual insurance or subscriber contract;
(b) coverage through:
(i) a health maintenance organization;
(ii) a preferred provider prepayment;
(iii) group practice;
(iv) individual practice plan; or
(v) health care insurance;
(c) coverage under an uninsured arrangement of group or group-type contracts includingemployer self-insured, cost-plus, or other benefits methodologies not involving insurance;
(d) coverage under a group type contract which is not available to the general public andcan be obtained only because of connection with a particular organization or group; and
(e) coverage by Medicare or other governmental benefit.
(12) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996,Pub. L. 104-191, 110 Stat. 1936.
(13) "HIPAA eligible" means an individual who is eligible under the provisions of theHealth Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.
(14) "Insurer" means:
(a) an insurance company authorized to transact accident and health insurance businessin this state;
(b) a health maintenance organization; or
(c) a self-insurer not subject to federal preemption.
(15) "Medicaid" means coverage under Title XIX of the Social Security Act, 42 U.S.C.Sec. 1396 et seq., as amended.
(16) "Medicare" means coverage under both Part A and B of Title XVIII of the SocialSecurity Act, 42 U.S.C. 1395 et seq., as amended.
(17) "Plan of operation" means the plan developed by the board in accordance withSection 31A-29-105 and includes the articles, bylaws, and operating rules adopted by the boardunder Section 31A-29-106.
(18) "Pool" means the Utah Comprehensive Health Insurance Pool created in Section31A-29-104.
(19) "Pool fund" means the Comprehensive Health Insurance Pool Enterprise Fundcreated in Section 31A-29-120.
(20) "Pool policy" means a health benefit plan policy issued under this chapter.
(21) "Preexisting condition" has the same meaning as defined in Section 31A-1-301.
(22) (a) "Resident" or "residency" means a person who is domiciled in this state.
(b) A resident retains residency if that resident leaves this state:
(i) to serve in the armed forces of the United States; or
(ii) for religious or educational purposes.
(23) "Third-party administrator" has the same meaning as provided in Section31A-1-301.
Amended by Chapter 3, 2008 General Session
Amended by Chapter 385, 2008 General Session