§ 38-74-10 Definitions
§ 38-74-20 South Carolina health insurance pool
§ 38-74-30 Eligibility for pool coverage
§ 38-74-40 Administration of pool
§ 38-74-50 Insurer’s assessment
§ 38-74-60 Major medical expense coverage
§ 38-74-70 Immunity
§ 38-74-80 Tax exemption and credits
§ 38-74-90 Director of Department of Insurance; promulgation of regulations

Terms Used In South Carolina Code > Title 38 > Chapter 74

  • Accident and health insurance: means insurance of human beings against death or personal injury by accident, and each insurance of human beings against sickness, ailment, and any type of physical disability resulting from accident or disease, and prepaid dental service, but not including coverages required by the Workers' Compensation Law of this State. See South Carolina Code 31-3-580
  • Admitted assets: means assets of an insurer considered admitted on the most recent statutory financial statement of the insurer filed with the department pursuant to Section 38-13-80. See South Carolina Code 31-3-580
  • Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
  • Appointment: means an individual designated by an official or authorized representative of an authorized insurer to act on its behalf as a producer. See South Carolina Code 31-3-580
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Board: means the board of directors of the pool. See South Carolina Code 33-39-620
  • Coinsurance: means a stipulation or requirement that the insured undertakes to be his own insurer to the extent that he fails to maintain insurance of a given percentage of the value of the property against loss or damage. See South Carolina Code 31-3-580
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Company: includes a corporation, fraternal organization, burial association, other association, partnership, society, order, individual, or aggregation of individuals engaging or proposing or attempting to engage as principals in any kind of insurance or surety business, including the exchanging of reciprocal or interinsurance contracts between individuals, partnerships, and corporations. See South Carolina Code 31-3-580
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: means a county business development corporation created under this chapter;

    (2) "Financial institution" means any banking corporation or trust company, building and loan association, insurance company or related corporation, partnership, foundation or other institution engaged primarily in lending or investing funds;

    (3) "Member" means any financial institution authorized to do business within this State which shall undertake to lend money to a corporation created under this chapter, upon its call, and in accordance with the provisions of this chapter;

    (4) "Board of directors" means the board of directors of the corporation created under this chapter; and

    (5) "Loan limit" means, for any member, the maximum amount permitted to be outstanding at one time on loans made by such member to the corporation as determined under the provisions of this chapter. See South Carolina Code 33-39-10
  • Creditable coverage: means , with respect to an individual, coverage of the individual under:

    (a) a group health plan;

    (b) health insurance;

    (c) Part A or B of Title XVIII of the Social Security Act;

    (d) Title XIX of the Social Security Act, other than coverage consisting solely of benefits under Section 1928;

    (e) Chapter 55, Title 10 of the United States Code;

    (f) a medical care program of the Indian Health Service or of a tribal organization;

    (g) a state health benefits risk pool, including the South Carolina Health Insurance Pool;

    (h) a health plan offered under Chapter 89, Title 5 of the United States Code;

    (i) a public health plan, as defined in regulations;

    (j) a health benefit plan under Section 5(e) of the Peace Corps Act (22 U. See South Carolina Code 33-39-620
  • Department: means the South Carolina Insurance Department. See South Carolina Code 33-39-620
  • Department: means the Department of Insurance of South Carolina. See South Carolina Code 31-3-580
  • Designee or deputy director: means the person or persons appointed by the director, serving at the will and pleasure of the director as his designee, to supervise and carry out the functions and duties of the department as provided by law. See South Carolina Code 31-3-580
  • Director: means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the Department of Insurance, including all of its divisions. See South Carolina Code 33-39-620
  • Director: means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the department. See South Carolina Code 31-3-580
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • 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.
  • Federally defined eligible individual: means an individual:

    (a) for whom, as of the date on which the individual seeks coverage under this chapter, the aggregate of the periods of creditable coverage is eighteen or more months;

    (b) whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan or health insurance coverage offered in connection with one of these plans;

    (c) who is not eligible for coverage under a group health plan, part A or part B of Title XVIII of the Social Security Act, or a state plan under Title XIX of the Social Security Act or any successor program and who does not have other health insurance coverage;

    (d) with respect to whom the most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;

    (e) who, if offered the option of continuation coverage under a COBRA continuation provision or under a similar state program, elected the coverage; and

    (f) who, if the individual elected the continuation coverage, has exhausted the continuation coverage under the provision or program. See South Carolina Code 33-39-620
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • health insurance coverage: means benefits consisting of medical care provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care under a hospital or medical service policy or certificate, hospital, or medical service plan contract, or health maintenance organization contract offered by an insurer, except:

    (a) coverage only for accident or disability income insurance, or any combination thereof;

    (b) coverage issued as a supplement to liability insurance;

    (c) liability insurance, including general liability insurance and automobile liability insurance;

    (d) workers' compensation or similar insurance;

    (e) automobile medical payment insurance;

    (f) credit-only insurance;

    (g) coverage for on-site medical clinics;

    (h) other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;

    (i) if offered separately:

    (i) limited scope dental or vision benefits;

    (ii) benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;

    (iii) such other similar, limited benefits as are specified in regulations;

    (j) if offered as independent, noncoordinated benefits:

    (i) coverage only for a specified disease or illness; and

    (ii) hospital indemnity or other fixed indemnity insurance;

    (k) if offered as a separate insurance policy, coverage supplement to the coverage provided under Chapter 55, Title 10 of the United States Code. See South Carolina Code 33-39-620
  • Hospital: means an institution operated pursuant to law under the supervision of a staff of duly licensed physicians which is primarily and continuously engaged in providing or operating, either on its premises or in facilities available to the public on a prearranged basis, medical, diagnostic, and major surgical facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made and provides twenty-four hour nursing service under the supervision of registered nurses. See South Carolina Code 33-39-620
  • Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See South Carolina Code 33-39-620
  • insurance: includes annuities. See South Carolina Code 31-3-580
  • Insurance company: means an "insurer". See South Carolina Code 31-3-580
  • Insured: means any individual resident of this State who is eligible to receive benefits from any insurer. See South Carolina Code 33-39-620
  • Insurer: means any entity that provides health insurance in this State. See South Carolina Code 33-39-620
  • Insurer: includes a corporation, fraternal organization, burial association, other association, partnership, society, order, individual, or aggregation of individuals engaging or proposing or attempting to engage as principals in any kind of insurance or surety business, including the exchanging of reciprocal or interinsurance contracts between individuals, partnerships, and corporations. See South Carolina Code 31-3-580
  • 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.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Medicare: means Title XVIII of the Social Security Act, 42 U. See South Carolina Code 33-39-620
  • Member: means each insurer participating in the pool. See South Carolina Code 33-39-620
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Net loss: means the excess of incurred claims plus expenses over the sum of earned premiums, accrued investment income, and other appropriate gains and losses. See South Carolina Code 33-39-620
  • 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: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 31-3-580
  • Plan of operation: means the plan of operation of the pool, including articles, bylaws, and operating rules adopted by the board. See South Carolina Code 33-39-620
  • Policy: means a contract of insurance. See South Carolina Code 31-3-580
  • Pool: means the South Carolina Health Insurance Pool. See South Carolina Code 33-39-620
  • Preexisting condition exclusion: means , with respect to 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. See South Carolina Code 33-39-620
  • Premium: means payment given in consideration of a contract of insurance. See South Carolina Code 31-3-580
  • Qualified TAA eligible individual: means an individual who is eligible for the credit for health insurance costs under Section 35 of the Internal Revenue Code of 1986. See South Carolina Code 33-39-620
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Statute: A law passed by a legislature.
  • 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 South Carolina Code 33-39-620