Terms Used In Rhode Island General Laws > Chapter 27-18.6 - Large Group Health Insurance Coverage

• Affiliation period: means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. See Rhode Island General Laws 27-18.6-2
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Beneficiary: has the meaning given that term under section 3(8) of the Employee Retirement Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Bona fide association: means , with respect to health insurance coverage in this state, an association which:

  (i)  Has been actively in existence for at least five (5) years;

  (ii)  Has been formed and maintained in good faith for purposes other than obtaining insurance;

  (iii)  Does not condition membership in the association on any health status-relating factor relating to an individual (including an employee of an employer or a dependent of an employee);

  (iv)  Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members (or individuals eligible for coverage through a member);

  (v)  Does not make health insurance coverage offered through the association available other than in connection with a member of the association;

  (vi)  Is composed of persons having a common interest or calling;

  (vii)  Has a constitution and bylaws; and

  (viii)  Meets any additional requirements that the director may prescribe by regulation;

  (4)  "COBRA continuation provision" means any of the following:

  (i)  Section 4980(B) of the Internal Revenue Code of 1986, 26 U. See Rhode Island General Laws 27-18.6-2

• carrier: means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical or dental service corporation, or any other entity providing a plan of health insurance, health benefits, or health services;

  (15)(i)  "Health insurance coverage" means a policy, contract, certificate, or agreement offered by a health insurance carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Rhode Island General Laws 27-18.6-2

• Church plan: has the meaning given that term under section 3(33) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Contract: A legal written agreement that becomes binding when signed.
• 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.
• Director: means the director of the department of business regulation;

  (8)  "Employee" has the meaning given that term under section 3(6) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

• Employee: has the meaning given that term under section 3(6) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Employer: has the meaning given that term under section 3(5) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Enrollment date: means , with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment;

  (11)  "Governmental plan" has the meaning given that term under section 3(32) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Fraud: Intentional deception resulting in injury to another.
• Governmental plan: has the meaning given that term under section 3(32) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with that plan;

  (13)  "Group health plan" means an employee welfare benefits plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

• Health status-related factor: means any of the following factors:

  (i)  Health status;

  (ii)  Medical condition, including both physical and mental illnesses;

  (iii)  Claims experience;

  (iv)  Receipt of health care;

  (v)  Medical history;

  (vi)  Genetic information;

  (vii)  Evidence of insurability, including contributions arising out of acts of domestic violence; and

  (viii)  Disability;

  (18)  "Large employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Rhode Island General Laws 27-18.6-2

• in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Large group market: means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer;

  (20)  "Late enrollee" means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:

  (i)  The first period in which the individual is eligible to enroll under the plan; or

  (ii)  A special enrollment period;

  (21)  "Medical care" means amounts paid for:

  (i)  The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;

  (ii)  Amounts paid for transportation primarily for and essential to medical care referred to in paragraph (i) of this subdivision; and

  (iii)  Amounts paid for insurance covering medical care referred to in paragraphs (i) and (ii) of this subdivision;

  (22)  "Network plan" means health insurance coverage offered by a health insurance carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier;

  (23)  "Participant" has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Participant: has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6
• Placed for adoption: means , in connection with any placement for adoption of a child with any person, the assumption and retention by that person of a legal obligation for total or partial support of the child in anticipation of adoption of the child. See Rhode Island General Laws 27-18.6-2
• Plan sponsor: has the meaning given that term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
• Preexisting condition exclusion: means , with respect to health insurance coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before the date; and

  (27)  "Waiting period" means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. See Rhode Island General Laws 27-18.6-2

• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8