58-33-93. Definitions relating to multiple employer welfare arrangements.
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/sd/title-58/chapter-58-33/58-33-93A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Terms used in §§ 58-33-93 to 58-33-116 , inclusive, mean:
(1)"Admitted insurer," an insurer licensed to do an insurance business in this state including an entity authorized pursuant to § 58-18-88 , a health maintenance organization or nonprofit hospital, or medical service corporation under the laws of this state;
(2)"Arrangement," a fund, trust, plan, program, or other mechanism by which a person provides, or attempts to provide, health care benefits;
(3)"Employee leasing arrangement," a labor leasing, staff leasing, employee leasing, professional employer organization, contract labor, extended employee staffing or supply, or other arrangement, under contract or otherwise, whereby one business or entity represents that it leases or provides its workers to another business or entity;
(4)"Employee welfare benefit plan" or "health benefit plan," a plan, fund, or program which is or was established or maintained by an employer or by an employee organization, or by both, to the extent that the plan, fund, or program is or was established or maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care or benefits, or benefits in the event of sickness, accident, disability, death, or unemployment;
(5)"Fully insured," for the health care benefits or coverage provided or offered by or through a health benefit plan or arrangement:
(a)An admitted insurer is directly obligated by contract to each participant to provide all of the coverage under the plan or arrangement; and
(b)The liability and responsibility of the admitted insurer to provide covered services or for payment of benefits is not contingent, and is directly to the individual employee, member, or dependent;
(6)"Licensee," a person that is, or that is required to be, licensed or registered under the laws of this state as a producer, third party administrator, insurer, or preferred provider organization;
(7)"MEWA," multiple employer welfare arrangement;
(8)"MEWA contact," the individual or position designated by the division to be the MEWA contact as identified on the division web site;
(9)"Nonadmitted insurer," an insurer not licensed to do insurance business in this state;
(10)"Preferred provider organization," an entity that engages in the business of offering a network of health care providers, whether or not on a risk basis, to employers, insurers, or any other person who provides a health benefit plan including a managed care contractor registered or required to be registered pursuant to § 58-17F-16 ;
(11)"Producer," a person required to be licensed pursuant to chapter 58-30 of this state to sell, solicit, or negotiate insurance;
(12)"Professional employer organization," an arrangement, under contract or otherwise, whereby one business or entity represents that it co-employs or leases workers to another business or entity for an ongoing and extended, rather than a temporary or project-specific, relationship;
(13)"Third party administrator" or "administrator," has the meaning provided in chapter 58-29D . (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029
(2010)is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")