TITLE 27

Insurance

CHAPTER 27-18.4

Health Insurance – Coordination with Federal Medicaid Program

SECTION 27-18.4-1



   § 27-18.4-1  Definitions. –

(a) "Insurer" means any health insurer (including a group health plan, as

defined in § 607(1) of the Employee Retirement Income Security Act of

1974, 29 U.S.C. § 1167(1)), a health maintenance organization as defined

in § 27-41-2, a qualified health maintenance organization as referred to

in § 42-62-9, a non-profit hospital service corporation as defined in

§ 27-19-1, a non-profit medical service corporation as defined in §

27-20-1, a non-profit dental service corporation as defined in §

27-20.1-1, a non-profit optometric service corporation as defined in §

27-20.2-1, self insured plans, pharmacy benefit managers (PBM), and other

parties that are by statute, contract, or agreement, legally responsible for

payment of a claim for a health care item of service doing business in the

state, a domestic insurance company subject to chapter 1 of this title, and a

foreign insurance company subject to chapter 2 of this title.



   (b) "Medical assistance" and "Medicaid" mean medical

assistance provided in whole or in part by the department of human services

pursuant to chapter 5.1, 8, 8.4 of title 40 or 12.3 of title 42 and/or title

XIX or XXI of the federal Social Security Act, as amended, 42 U.S.C. §

1396 et seq. and 42 U.S.C. § 1397aa et seq., respectively.



History of Section.

(P.L. 1994, ch. 237, § 2; P.L. 2002, ch. 65, art. 35, § 2; P.L. 2007,

ch. 73, art. 18, § 5.)