Sec. 21.56.250. Definitions.

549 words·~2 min read·/ak/title-21/chapter-56/21-56-250

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

In this chapter,

(1)“actuarial certification” means a written statement by a member of the American Academy of Actuaries or another individual acceptable to the director indicating that, based on the person's examination, including a review of the appropriate records, actuarial assumptions, and methods used by the insurer in establishing premium rates for applicable health insurance plans, a small employer insurer is in compliance with the provisions of AS 21.56.120 ;

(2)“affiliated” means a person who directly or indirectly, through one or more intermediaries, controls or is controlled by or is under common control with a specified person;

(3)“base premium rate” means the lowest premium rate charged or that could have been charged under the rating system by the small employer insurer to small employers with similar case characteristics for health care insurance plans with the same or similar coverage;

(4)“basic health care insurance plan” means a lower cost plan offered under AS 21.56.140 ;

(5)“beneficiary” has the meaning given in AS 21.54.500 ;

(6)“case characteristics” means demographic or other objective characteristics of a small employer that are considered by the small employer insurer in the determination of premium rates for the small employer, except that claim experience, health status, and duration of coverage may not be case characteristics for the purposes of this chapter;

(7)“eligible employee” means an employee who works on a full-time basis, with a normal work week of 30 or more hours; “eligible employee” includes a sole proprietor, a partner of a partnership, or an independent contractor if the sole proprietor, partner, or contractor is included as an employee under a health care insurance plan of a small employer, but does not include an employee who works on a part-time, temporary, or substitute basis;

(8)“employee” has the meaning given in AS 21.54.500 ;

(9)“group market” has the meaning given in AS 21.54.500 ;

(10)“health care insurance plan” has the meaning given in AS 21.54.500 ;

(11)“health care insurer” has the meaning given in AS 21.54.500 ;

(12)“health status factor” has the meaning given in AS 21.54.500 ;

(13)“index rate” means, for small employers with similar case characteristics and plan designs as determined by the insurer for a rating period, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate;

(14)“late enrollee” has the meaning given in AS 21.54.500 ;

(15)“network plan” has the meaning given in AS 21.54.500 ;

(16)“new business premium rate” means the lowest premium rate charged or offered, or that could have been charged or offered, by the small employer insurer to small employers with similar case characteristics for newly issued health care insurance plans with the same or similar coverage;

(17)“rating period” means the calendar period for which premium rates established by a small employer insurer are assumed to be in effect;

(18)“small employer” has the meaning given in AS 21.54.500 ;

(19)“small employer insurer” means a health care insurer offering, issuing for delivery, delivering, or renewing health care insurance to small employers in the state;

(20)“standard health care insurance plan” means a health care insurance plan offered under AS 21.56.140 that includes more comprehensive benefits than under a basic health care insurance plan.