(1) "Administrator" The Pool Administrator selected by the Executive Director in accordance withthis Part.
(2) "Benefitplan" The coverage offered by the Pool to eligible individuals.
(3) "Board" TheBoard of Directors of the Pool.
(4) "Commissioner" The Commissioner of Insurance of North Carolina or the Commissioner'sauthorized designee.
(5) "Coveredperson" Any individual resident of this State, excluding dependents, whois receiving or is eligible to receive medical care benefits from any insurer.
(6) "Creditablecoverage" The same meaning as defined in G.S. 58‑68‑30(c)(1).
(7) "Dependent" A resident spouse, an unmarried child under the age of 19 years, a child whois a full‑time student under the age of 23 years and who is financiallydependent upon the parent or guardian, a child who is over 18 years of age andfor whom a person may be obligated to pay child support, or a child of any agewho is disabled and dependent upon the parent or guardian.
(8) "ExecutiveDirector" The individual selected by a majority vote of the Boardmembers and hired to serve as the Executive Director of the Pool.
(9) "Federallydefined eligible individual" The same meaning as the defined term"eligible individual" in G.S. 58‑68‑60(b).
(9a) "Fund." TheNorth Carolina Health Insurance Risk Pool Fund.
(10) "Healthinsurance coverage" The same meaning as defined in G.S. 58‑68‑25(a)(5)but does not include benefits described in G.S. 58‑68‑25(b).
(11) "Insurancearrangement" The plan, program, contract, or other arrangement throughwhich medical care is provided by an employer to its officers or employees butdoes not include medical care covered through an insurer.
(12) "Insured" An individual who is eligible to receive benefits from the Pool.
(13) "Insurer" Any entity, other than the Pool, that provides medical care benefits, includingexcess or stop‑loss insurance, that covers medical care or administersmedical care on any individual in this State. For the purposes of this Part,insurer includes:
a. An insurancecompany;
b. A hospital ormedical service corporation;
c. A health maintenanceorganization;
d. A multiple employerwelfare arrangement;
e. A third‑partyadministrator or claims processor; and
f. Any othernongovernmental entity providing a health benefit plan subject to Stateinsurance regulation.
Insurerdoes not include an entity to the extent the entity provides excepted benefitsas defined in G.S. 58‑68‑25(b).
(14) "Medicalcare" All of the following:
a. The diagnosis, cure,mitigation, treatment, or prevention of disease, or amounts paid for thepurpose of affecting any structure or function of the body;
b. Transportationprimarily for and essential to medical care referred to in sub‑subdivisiona. of this subdivision; and
c. Insurance coveringmedical care referred to in sub‑subdivisions a. and b. of thissubdivision.
(15) "Plan ofOperation" The articles, bylaws, and operating rules and proceduresadopted by the Board in accordance with this Part.
(16) "Pool" TheNorth Carolina Health Insurance Risk Pool.
(17) "Provider" An individual or entity that provides medical care to individuals residing inthis State.
(18) "Resident" An individual who has legal status in the United States and who:
a. Has been legallydomiciled in this State for a period of at least 30 days, except that for afederally defined eligible individual, there shall not be a 30‑dayrequirement;
b. Is legally domiciledin this State on the date of application to the Pool and who is eligible forenrollment in the Pool as a result of the Health Insurance Portability andAccountability Act of 1996; or
c. Is legally domiciledin this State on the date of application to the Pool and is eligible for thecredit for health insurance costs under section 35 of the Internal Revenue Codeof 1986.
(19) Recodified as G.S. 58‑50‑175(9a).
(20) "TradeAdjustment Assistance Program" (TAA) Title II of the Trade Act of 2002,P.L. 107‑210. (2007‑532, s. 1.1; 2008‑118, s. 3.2(a).)
(1) "Administrator" The Pool Administrator selected by the Executive Director in accordance withthis Part.
(2) "Benefitplan" The coverage offered by the Pool to eligible individuals.
(3) "Board" TheBoard of Directors of the Pool.
(4) "Commissioner" The Commissioner of Insurance of North Carolina or the Commissioner'sauthorized designee.
(5) "Coveredperson" Any individual resident of this State, excluding dependents, whois receiving or is eligible to receive medical care benefits from any insurer.
(6) "Creditablecoverage" The same meaning as defined in G.S. 58‑68‑30(c)(1).
(7) "Dependent" A resident spouse, an unmarried child under the age of 19 years, a child whois a full‑time student under the age of 23 years and who is financiallydependent upon the parent or guardian, a child who is over 18 years of age andfor whom a person may be obligated to pay child support, or a child of any agewho is disabled and dependent upon the parent or guardian.
(8) "ExecutiveDirector" The individual selected by a majority vote of the Boardmembers and hired to serve as the Executive Director of the Pool.
(9) "Federallydefined eligible individual" The same meaning as the defined term"eligible individual" in G.S. 58‑68‑60(b).
(9a) "Fund." TheNorth Carolina Health Insurance Risk Pool Fund.
(10) "Healthinsurance coverage" The same meaning as defined in G.S. 58‑68‑25(a)(5)but does not include benefits described in G.S. 58‑68‑25(b).
(11) "Insurancearrangement" The plan, program, contract, or other arrangement throughwhich medical care is provided by an employer to its officers or employees butdoes not include medical care covered through an insurer.
(12) "Insured" An individual who is eligible to receive benefits from the Pool.
(13) "Insurer" Any entity, other than the Pool, that provides medical care benefits, includingexcess or stop‑loss insurance, that covers medical care or administersmedical care on any individual in this State. For the purposes of this Part,insurer includes:
a. An insurancecompany;
b. A hospital ormedical service corporation;
c. A health maintenanceorganization;
d. A multiple employerwelfare arrangement;
e. A third‑partyadministrator or claims processor; and
f. Any othernongovernmental entity providing a health benefit plan subject to Stateinsurance regulation.
Insurerdoes not include an entity to the extent the entity provides excepted benefitsas defined in G.S. 58‑68‑25(b).
(14) "Medicalcare" All of the following:
a. The diagnosis, cure,mitigation, treatment, or prevention of disease, or amounts paid for thepurpose of affecting any structure or function of the body;
b. Transportationprimarily for and essential to medical care referred to in sub‑subdivisiona. of this subdivision; and
c. Insurance coveringmedical care referred to in sub‑subdivisions a. and b. of thissubdivision.
(15) "Plan ofOperation" The articles, bylaws, and operating rules and proceduresadopted by the Board in accordance with this Part.
(16) "Pool" TheNorth Carolina Health Insurance Risk Pool.
(17) "Provider" An individual or entity that provides medical care to individuals residing inthis State.
(18) "Resident" An individual who has legal status in the United States and who:
a. Has been legallydomiciled in this State for a period of at least 30 days, except that for afederally defined eligible individual, there shall not be a 30‑dayrequirement;
b. Is legally domiciledin this State on the date of application to the Pool and who is eligible forenrollment in the Pool as a result of the Health Insurance Portability andAccountability Act of 1996; or
c. Is legally domiciledin this State on the date of application to the Pool and is eligible for thecredit for health insurance costs under section 35 of the Internal Revenue Codeof 1986.
(19) Recodified as G.S. 58‑50‑175(9a).
(20) "TradeAdjustment Assistance Program" (TAA) Title II of the Trade Act of 2002,P.L. 107‑210. (2007‑532, s. 1.1; 2008‑118, s. 3.2(a).)
(1) "Administrator" The Pool Administrator selected by the Executive Director in accordance withthis Part.
(2) "Benefitplan" The coverage offered by the Pool to eligible individuals.
(3) "Board" TheBoard of Directors of the Pool.
(4) "Commissioner" The Commissioner of Insurance of North Carolina or the Commissioner'sauthorized designee.
(5) "Coveredperson" Any individual resident of this State, excluding dependents, whois receiving or is eligible to receive medical care benefits from any insurer.
(6) "Creditablecoverage" The same meaning as defined in G.S. 58‑68‑30(c)(1).
(7) "Dependent" A resident spouse, an unmarried child under the age of 19 years, a child whois a full‑time student under the age of 23 years and who is financiallydependent upon the parent or guardian, a child who is over 18 years of age andfor whom a person may be obligated to pay child support, or a child of any agewho is disabled and dependent upon the parent or guardian.
(8) "ExecutiveDirector" The individual selected by a majority vote of the Boardmembers and hired to serve as the Executive Director of the Pool.
(9) "Federallydefined eligible individual" The same meaning as the defined term"eligible individual" in G.S. 58‑68‑60(b).
(9a) "Fund." TheNorth Carolina Health Insurance Risk Pool Fund.
(10) "Healthinsurance coverage" The same meaning as defined in G.S. 58‑68‑25(a)(5)but does not include benefits described in G.S. 58‑68‑25(b).
(11) "Insurancearrangement" The plan, program, contract, or other arrangement throughwhich medical care is provided by an employer to its officers or employees butdoes not include medical care covered through an insurer.
(12) "Insured" An individual who is eligible to receive benefits from the Pool.
(13) "Insurer" Any entity, other than the Pool, that provides medical care benefits, includingexcess or stop‑loss insurance, that covers medical care or administersmedical care on any individual in this State. For the purposes of this Part,insurer includes:
a. An insurancecompany;
b. A hospital ormedical service corporation;
c. A health maintenanceorganization;
d. A multiple employerwelfare arrangement;
e. A third‑partyadministrator or claims processor; and
f. Any othernongovernmental entity providing a health benefit plan subject to Stateinsurance regulation.
Insurerdoes not include an entity to the extent the entity provides excepted benefitsas defined in G.S. 58‑68‑25(b).
(14) "Medicalcare" All of the following:
a. The diagnosis, cure,mitigation, treatment, or prevention of disease, or amounts paid for thepurpose of affecting any structure or function of the body;
b. Transportationprimarily for and essential to medical care referred to in sub‑subdivisiona. of this subdivision; and
c. Insurance coveringmedical care referred to in sub‑subdivisions a. and b. of thissubdivision.
(15) "Plan ofOperation" The articles, bylaws, and operating rules and proceduresadopted by the Board in accordance with this Part.
(16) "Pool" TheNorth Carolina Health Insurance Risk Pool.
(17) "Provider" An individual or entity that provides medical care to individuals residing inthis State.
(18) "Resident" An individual who has legal status in the United States and who:
a. Has been legallydomiciled in this State for a period of at least 30 days, except that for afederally defined eligible individual, there shall not be a 30‑dayrequirement;
b. Is legally domiciledin this State on the date of application to the Pool and who is eligible forenrollment in the Pool as a result of the Health Insurance Portability andAccountability Act of 1996; or
c. Is legally domiciledin this State on the date of application to the Pool and is eligible for thecredit for health insurance costs under section 35 of the Internal Revenue Codeof 1986.
(19) Recodified as G.S. 58‑50‑175(9a).
(20) "TradeAdjustment Assistance Program" (TAA) Title II of the Trade Act of 2002,P.L. 107‑210. (2007‑532, s. 1.1; 2008‑118, s. 3.2(a).)
