58-12-26. Insurer defined. For the purposes of §§ 58-12-22 to 58-12-29, inclusive, the term, insurer, means:
(1) Any commercial insurance company, employer-employee benefit plan, health maintenance organization, professional association, service benefit plan, public self-funded employer or pool, union, or fraternal group selling or otherwise offering individual or group health insurance coverage including self-insured and self-funded plans;
(2) Any profit or nonprofit prepaid plan offering either medical services of full or partial payment for services included in the department's medicaid plan;
(3) Any other entity offering health benefits for which a medicaid recipient may be eligible in addition to public medical assistance;
(4) Any managed care organization, third-party administrator, pharmacy benefits manager, or other entity which processes claims, administers services, or otherwise manages health benefits on behalf of any of the aforementioned insurers; or
(5) Any other party that is by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service including workers' compensation, automobile insurance, and liability insurance plans.Source: SL 2005, ch 263, § 5; SL 2007, ch 286, § 3.
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