Title 33, Chapter 30A, Section 1
As used in this chapter, the term:
(1) "Agent" shall be defined as provided in Code Section 33-23-1.
(2) "Carrier" means any entity that provides health insurance to employers in this state. For the purposes of this chapter, carrier includes an insurance company, hospital or medical service corporation, health care plan as defined in Code Section 33-20-3, fraternal benefit society, health maintenance organization, or any other licensed entity providing a plan of health insurance or health benefits subject to state insurance regulation.
(3) "Health benefit plan" means any hospital or medical insurance policy or certificate, health care plan contract or certificate, qualified higher deductible health plan, or health maintenance organization subscriber contract. Health benefit plan does not include policies issued in accordance with Chapter 31 of this title; disability income policies; policies issued in accordance with Code Section 34-9-14 or 34-9-122.1; limited accident and sickness insurance policies such as credit, dental, vision, medicare supplement, long-term care, hospital indemnity, or specified disease insurance; coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; or automobile medical payment insurance.
(4) "Health plan purchasing cooperative," "purchasing
cooperative," or "cooperative" means a nonprofit corporation
authorized by the Commissioner pursuant to this chapter and
operated for the benefit of members located within a particular
geographic area of the state by providing members with purchasing
services and detailed information on comparative prices, usage,
medical outcomes, quality, and enrollee satisfaction through
selected health benefit plans. For purposes of Chapter 30 of this
title, a health plan purchasing cooperative shall be considered as
a true group and not as an association.
(5) "Medical outcome" means a change in an individual's health
status after the provision of health services.
(6) "Premium" means all moneys paid by an employer and eligible
employees as a condition of receiving coverage from a carrier,
including any fees or other contributions associated with the
health benefit plan. Premiums shall not include fees for
membership in the cooperative.
(7) "Small employer" means any person, firm, corporation,
partnership, association, political subdivision, or sole
proprietor that is actively engaged in a business that, at the
time of application, on at least 50 percent of its working days
during the preceding calendar quarter, employed no fewer than two
and no more than 50 eligible employees, in which a bona fide
employer-employee relationship exists. In determining the number
of eligible employees, companies that are affiliated companies or
companies that are eligible to file a combined tax return for
purposes of state taxation shall be considered one employer.
Subsequent to the issuance of a health benefit plan to a small
employer and for the purpose of determining eligibility, the size
of a small employer shall be determined annually. Except as
otherwise provided, provisions of this chapter that apply to a
small employer shall continue to apply at least until the plan
anniversary following the date the small employer no longer meets
the requirements of this paragraph. Nothing in this chapter shall
be construed to prohibit a carrier from including self-employed
individuals in its definition of small employer.