23 CAR § 147-103. Definitions

The following words and terms, when used in this part, shall have the following meanings, unless the context clearly indicates otherwise: (1) "Board" means the board of trustees or directors, as applicable, of a multiple-employer welfare arrangement; (2) “Business plan” means the comprehensive, detailed plan by which the multiple-employer welfare arrangement conducts or proposes to conduct its business; (3) "Employee welfare benefit plan" has the meaning assigned by Section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1); (4) “Employer” has the meaning assigned by Section 3(5) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(5), and shall include sole proprietors, as permitted by federal law; (5)(A) "Health benefit plan" includes any plan that provides benefits for healthcare services. (B) The term does not include: (i) Accident-only or disability income insurance coverage, or a combination of accident-only and disability income insurance coverage; (ii) Credit-only insurance coverage; (iii) Disability insurance; (iv) Coverage for a specified disease or illness; (v) Medicare services under a federal contract; (vi) Medicare supplement and Medicare Select policies regulated in accordance with federal law; (vii) Long-term care coverage or benefits, nursing home care coverage or benefits, home healthcare coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits; (viii) Coverage that provides limited-scope dental or vision benefits; (ix) Coverage provided by a single-service health maintenance organization; (x) Workers’ compensation insurance coverage or similar insurance coverage; (xi) Coverage provided through a jointly managed trust authorized under 29 U.S.C. § 141 et seq., that contains a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. § 157; (xii) Hospital indemnity or other fixed indemnity insurance coverage; (xiii) Reinsurance contracts issued on a stop-loss, quota-share, or similar basis; (xiv) Short-term major medical contracts; (xv) Liability insurance coverage, including general liability insurance coverage and automobile liability insurance coverage; (xvi) Coverage issued as a supplement to liability insurance coverage; (xvii) Automobile medical payment insurance coverage; (xviii) Coverage for on-site medical clinics; (xix) Coverage that provides other limited benefits specified by federal regulations; or (xx) Other coverage that is: (a) Similar to the coverage described by this subdivision (5) under which benefits for medical care are secondary or incidental to other coverage benefits; and (b) Specified in federal regulations; (6) "Health status related factor" means: (A) Health status; (B) Medical condition, including both physical and mental illness; (C) Claims experience; (D) Receipt of health care; (E) Medical history; (F) Genetic information; (G) Evidence of insurability, including conditions arising out of acts of family violence; and (H) Disability; (7) "Multiple-employer welfare arrangement" has the meaning assigned by Section 3(40) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(40); (8) "Organizational document" means the articles, bylaws, agreements, trusts, or other documents or instruments describing the rights and obligations of employers, employees, and beneficiaries with respect to a multiple-employer welfare arrangement; and (9) "Participation criteria" means any criteria or rules established by an employer to determine the employees who are eligible for enrollment or continued enrollment under the terms of a health benefit plan.