§1901. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms
have the following meanings. [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
1.
"Administrator" means any person who, on behalf of a plan sponsor, health care service
plan, health maintenance organization or insurer, receives or collects charges, contributions
or premiums for, or adjusts or settles claims on residents of this State in connection
with any type of life, annuity, health, workers' compensation or employee benefit
excess insurance benefit provided in or as an alternative to insurance as defined
by sections 702 to 704, former Title 39 or Title 39-A, other than any of the following:
A. An employer on behalf of the employer's employees or the employees of one or more
subsidiary or affiliated corporations of the employer; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
B. A union on behalf of its members; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
C. A plan sponsor administering its own plan; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
D. An insurance company that is:
(1) Authorized to transact insurance business in this State; or
(2) Acting as an insurer with respect to a policy lawfully issued and delivered
by that company in and pursuant to the laws of a state in which the insurer was authorized
to transact an insurance business; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
E. A nonprofit hospital, medical or health care services plan, health maintenance organization,
professional service plan corporation or person in the business of providing continuing
care, possessing a valid certificate of authority issued by the Bureau of Insurance,
and the sole representative of that person, plan, organization or corporation, if
the activities of the plan, organization, corporation or person are limited to the
activities permitted under the certificate of authority; [1993, c. 702, Pt. A, §10 (AMD).]
F. An insurance agent or broker licensed in this State, whose activities are limited
to the scope of that license; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
G. An adjuster licensed in this State, whose activities are limited to the adjustment
of claims; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
H. A creditor on behalf of the creditor's debtors with respect to insurance covering
a debt between the creditor and its debtors; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
I. A trust and its trustees, agents, and employees acting pursuant to a trust established
in conformity with 29 United States Code, Section 186; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
J. A trust exempt from taxation under the federal Internal Revenue Code of 1986, Section
501(a), and the trustees and employees acting pursuant to that trust, or a custodian
and its agents and employees, including individuals representing the trustees in overseeing
the activities of a service company or administrator, acting pursuant to a custodial
account that meets the requirements of the federal Internal Revenue Code of 1986,
Section 401(f); [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
K. A financial institution or a mortgage lender that collects and remits premiums to
licensed insurance agents or authorized insurers concurrently or in connection with
mortgage loan payments; [1997, c. 457, §28 (AMD).]
L. A credit card issuing company that advances for and collects premiums or charges
from its credit card holders who have authorized that collection if the company does
not adjust or settle claims; [1989, c. 846, Pt. D, §2 (NEW); 1989, c. 846, Pt. E, §4 (AFF).]
M. A person who adjusts or settles claims in the normal course of that person's practice
or employment as an attorney and who does not collect charges or premiums in connection
with life or health insurance coverage; [1995, c. 673, Pt. A, §1 (AMD).]
N. A person acting as a trustee, named fiduciary or plan official of an employee benefit
plan within the meaning of the federal Employee Retirement Income Security Act of
1974, as amended, 29 United States Code, Section 1001, et seq.; and [1995, c. 673, Pt. A, §1 (AMD).]
O. A private purchasing alliance licensed in accordance with chapter 18-A. [1995, c. 673, Pt. A, §2 (NEW).]
Notwithstanding any other provision of this subsection, "administrator" includes any
administrator of a preferred provider arrangement required to register under this
chapter pursuant to section 2674-A.
[
2003, c. 428, Pt. C, §1 (AMD)
.]
2.
"ATF" means an administrator trust fund that is a special fiduciary account, established
and maintained by an administrator under section 1909, in which contributions and
premiums are deposited.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
3.
"CASA" means a claims administration services account that is a special fiduciary
account, established and maintained by an administrator under section 1909, from which
claims and claims adjustment expenses are disbursed.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
4.
"Charges" means any compensation paid by a plan sponsor, health care service plan,
health maintenance organization or insurer for services performed by the administrator.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
5.
"Contributions" means the value of funds that have been provided or are to be applied
by a plan sponsor or other entity to fund the self-insured portion of any plan, or
premiums charged to a plan sponsor or other entity by an insurer for coverage under
contracts of insurance or excess insurance. Contributions include administrative
fees charged to a covered individual. "Administrative fee" means any compensation
paid by a covered individual for services performed by the administrator.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
6.
"Covered individual" means any individual eligible for life, annuity, workers' compensation
or health benefits under a plan.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
7.
"Plan" means any plan, fund or program established or maintained by a plan sponsor,
health care service plan, health maintenance organization or insurer to the extent
that the plan, fund or program was established or is maintained to provide through
insurance or alternatives to insurance any type of life, annuity, health or workers'
compensation benefit within the scope of sections 702 to 704, former Title 39 or Title
39-A.
[
1991, c. 885, Pt. E, §26 (AMD);
1991, c. 885, Pt. E, §47 (AFF)
.]
8.
"Plan sponsor" means any person, other than an insurer, who establishes or maintains
a plan covering residents of this State, including, but not limited to, plans established
or maintained by 2 or more employers or jointly by one or more employers and one or
more employee organizations, the association, committee, joint board of trustees or
other similar group of representatives of the parties that establish or maintain the
plan.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
9.
"Premium" means any money charged a covered individual, plan sponsor or other entity
to provide life, accident, workers' compensation or health insurance under a plan.
The term "premium" includes amounts paid by or charged to a covered individual plan
sponsor or other entity for stop loss or excess insurance.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
10.
"Quasi-resident" means a nonresident licensee who receives or collects 50% or more
of calendar year contributions, premium volume or other funds subject to administration
from plan sponsors or insureds resident in this State.
[
1989, c. 846, Pt. D, §2 (NEW);
1989, c. 846, Pt. E, §4 (AFF)
.]
SECTION HISTORY
1989, c. 846, §§D2,E4 (NEW).
1991, c. 885, §§E25,26 (AMD).
1991, c. 885, §E47 (AFF).
1993, c. 702, §A10 (AMD).
1995, c. 673, §§A1,2 (AMD).
1997, c. 457, §28 (AMD).
1999, c. 609, §2 (AMD).
2003, c. 428, §C1 (AMD).
