As used in this Article, the following terms have the meanings specified:

(1) “Group policy” means a group accident and health insurance policy issued by an insurance company and a group contract issued by a service corporation or health maintenance organization or similar corporation or organization.

Terms Used In North Carolina General Statutes 58-53-1

  • Contract: A legal written agreement that becomes binding when signed.
  • converted policy: means an individual health insurance policy issued by an insurance company or an individual contract issued by a service corporation or health maintenance organization or similar corporation or organization. See North Carolina General Statutes 58-53-1
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Dependent: A person dependent for support upon another.
  • employee: includes an insured spouse or dependent of a member or of an employee. See North Carolina General Statutes 58-53-1
  • following: when used by way of reference to any section of a statute, shall be construed to mean the section next preceding or next following that in which such reference is made; unless when some other section is expressly designated in such reference. See North Carolina General Statutes 12-3
  • Group policy: means a group accident and health insurance policy issued by an insurance company and a group contract issued by a service corporation or health maintenance organization or similar corporation or organization. See North Carolina General Statutes 58-53-1
  • insured: refer to coverage under a group policy, individual policy or converted policy on a premium-paying basis, and do not include coverage provided by reason of a disability extension. See North Carolina General Statutes 58-53-1
  • Premium: includes any premium or other consideration payable for coverage under a group or individual policy. See North Carolina General Statutes 58-53-1
  • United States: shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 12-3

(2) “Individual policy” or “converted policy” means an individual health insurance policy issued by an insurance company or an individual contract issued by a service corporation or health maintenance organization or similar corporation or organization.

(3) “Insurance” and “insured” refer to coverage under a group policy, individual policy or converted policy on a premium-paying basis, and do not include coverage provided by reason of a disability extension.

(4) “Insurer” means the entity issuing a group policy or an individual or converted policy.

(5) “Medicare” means Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded.

(5a) “Member” or “employee” includes an insured spouse or dependent of a member or of an employee.

(6) “Premium” includes any premium or other consideration payable for coverage under a group or individual policy.

(7) “Reasonable and customary” means the most frequently used level of charge made for the supplies or for a specific service in the geographic subarea in which such supplies or services are received, of like kind or by physicians, or other practitioners, with similar qualifications. (1981, c. 706, s. 1; 1983, c. 142, s. 1; 1997-259, s. 10.)

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