20-336. Definitions

(Conditionally Rpld.)

In this article, unless the context otherwise requires:

1. " Certified application counselor" means an individual who is licensed pursuant to this article and who is authorized by the United States department of health and human services to perform the activities and duties of a certified application counselor as described by 45 Code of Federal Regulations section 155.225.

2. " Exchange" means a health benefit exchange that is established or operated by the secretary of the United States department of health and human services pursuant to 42 United States Code section 18031.

3. " Health benefit plan" :

(a) Means a hospital and medical service corporation policy or certificate, a health care services organization contract or certificate of coverage, an individual or group or blanket disability policy or certificate of coverage, a certificate of insurance of a group disability policy that is not issued in this state, a multiple employer welfare arrangement or any other arrangement under which health services or health benefits are provided to one or more individuals.

(b) Does not include:

(i) An insurance policy that is designed, advertised and marketed to supplement major medical insurance, which includes accident only, vision only, disability income only, fixed or hospital indemnity, specified disease insurance, credit insurance or Taft-Hartley trusts.

(ii) Coverage that is issued as a supplement to liability insurance.

(iii) Medicare supplemental insurance.

(iv) Workers' compensation insurance.

(v) Automobile medical payment insurance.

(vi) Long-term care insurance.

4. " Issuer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation, dental service corporation, prepaid dental plan organization or hospital, medical, dental and optometric service corporation.

5. " Navigator" means a person who is licensed pursuant to this article and who is certified or compensated by the United States department of health and human services to perform the activities and duties described by 42 United States Code section 18031 and 45 Code of Federal Regulations section 155.215.