044-71 Wyo. Code R. §§ 71-3 - Definitions

for purposes of this Chapter are as follows:

(a) "Administrative Services Only (ASO) Contract" means an arrangement in which an employer hires a third party to deliver administrative services to the employer such as claims processing and billing; the employer bears the risk for claims.

(b) "Carrier" shall be as defined in W.S. § 26-19-302(a)(v).

(c) "Commissioner" means the Wyoming Insurance Commissioner.

(d) "Department" means the Wyoming Department of Insurance.

(e) "Employee Welfare Benefit Plan," as used in this Chapter, has the same meaning as that contained in 29 U.S.C. § 1002(1).

(f) "Employer" for purposes of this Chapter means a group of employers that will be treated as the "employer" sponsor of a single multiple-employer employee welfare benefit plan, or "group health plan" as those terms are defined in Title I of the Employee Retirement Income Security Act (ERISA) of 1974, 29 U.S.C. § 1001 et seq., as amended.

(g) "Fully Insured Health Benefit Plan" means a health benefit plan in which the MEWA purchases health coverage from a state-licensed insurer and the insurer assumes the risk of paying the medical claims of the MEWA's enrolled members.

(h) "Health Benefit Plan" means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service plan contract or health maintenance organization subscriber contract. "Health benefit plan" does not include accident-only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance or automobile medical-payment insurance, nor does it include policies or certificates of specified disease, hospital confinement indemnity or limited benefit health insurance if the carrier offering the policies or certificates certifies to the commissioner that policies or certificates described in this paragraph are being offered and marketed as supplemental health insurance and not as a substitute for hospital or medical expense insurance or major medical expense insurance as defined in W.S. § 26-19-302(a)(xii).

(i) "Insurer" shall be as defined in W.S. § 26-1-102(a)(xvi).

(j) "Member" means any employee or former employee of an employer, or any current or former participant of an employee organization, or eligible dependent of an employee who is or may become eligible to receive a benefit of any type from an employee welfare benefit plan which covers employees of such employer or members of such organization, or whose beneficiaries may be eligible to receive any such benefit.

(k) "Multiple Employer Welfare Arrangement" or "MEWA", for purposes of this Chapter, shall be as defined in W.S. § 26-1-102(a)(xliii).

(l) "Qualified Actuary" means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards for actuaries signing the statements and who meets the requirements specified in the valuation manual.

(m) "Self-Insured Health Benefit Plan" means a health benefit plan that is provided directly by the MEWA for its members by providing funds to pay for a health benefit plan directly and the MEWA bearing the risk for covering medical claims.

(n) "Third Party Administrator" or "TPA" means a person who directly or indirectly underwrites, collects, charges collateral or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity, health, or stop-loss coverage offered or provided by a MEWA.

Notes

044-71 Wyo. Code R. §§ 71-3

Adopted, Eff. 1/6/2020. Amended, Eff. 2/9/2022.