147
‘‘(C) worker’s compensation or similar in-
surance, or
‘‘(D) automobile medical-payment insur-
ance.
‘‘(2) EMPLOYMENT-RELATED HEALTH PLAN.—
The term ‘employment-related health plan’ means
any health plan provided or arranged for or contrib-
uted to by the employer or an employment-related
organization to provide health benefits (directly or
indirectly) for the employer’s employees and depend-
ents, but only insofar as such benefits provide re-
quired health care services for pregnant women and
children.
‘‘(3) INSURED EMPLOYMENT-RELATED HEALTH
PLAN.—The 
term 
‘insured 
employment-related
health plan’ means an employment-related health
plan that has been provided by a person authorized
under applicable State insurance law, and does not
include any self-insured employment-related health
plan.
‘‘(4) 
SELF-INSURED
EMPLOYMENT-RELATED
HEALTH PLAN.—The term ‘self-insured employment-
related health plan’ means an employment-related
health plan which is an employee welfare benefit
plan (as defined in the Employee Retirement Income
148
Security Act of 1964) and in which the employer or
employment-related group assumes the underwriting
risk for the plan (whether or not there is any rein-
surance or similar mechanism to underwrite a por-
tion of that risk).
‘‘(5) SMALL
EMPLOYER
HEALTH
PLAN.—The
term ‘small employer health plan’ means an insured
employment-related health plan insofar as it offers
benefits with respect to any small employer, as de-
fined in subsection (c)(8), or the employees of a
small employer.
‘‘(b) CARRIER; HEALTH MAINTENANCE ORGANIZA-
TION; AND OTHER DEFINITIONS RELATING
TO CAR-
RIERS.—In this part:
‘‘(1) CARRIER.—The term ‘carrier’ means any
person that offers a health plan, whether through in-
surance or otherwise, including a licensed insurance
company, a prepaid hospital or medical service plan,
a health maintenance organization, and a multiple
employer welfare arrangement.
‘‘(2) HEALTH MAINTENANCE ORGANIZATION.—
The term ‘health maintenance organization’ has the
meaning given the term ‘eligible organization’ in sec-
tion 1876(b).
149
‘‘(3) SMALL
EMPLOYER
CARRIER.—The term
‘small employer carrier’ means any carrier which of-
fers a small employer health plan.
‘‘(c) GENERAL DEFINITIONS.—In this part:
‘‘(1) APPLICABLE REGULATORY AUTHORITY.—
The term ‘applicable regulatory authority’ means,
with respect to a health plan offered in a State, the
State commissioner or superintendent of insurance
or other State authority responsible for regulation of
health insurance, or, if the Secretary is exercising
authority under section 2301(a)(2) in the State, the
Secretary.
‘‘(2) BLOCK OF BUSINESS.—The term ‘block of
business’ means all, or a distinct grouping of, small
employers as shown on the records of the small em-
ployer carrier, if established consistent with section
2304(b)(3).
‘‘(3) COMMUNITY.—The term ‘community’ has
the meaning given such term in section 2231(b).
‘‘(4) FULL-TIME EMPLOYEE.—The term ‘full-
time employee’ has the meaning given such term in
section 2181(b)(1).
‘‘(5) NAIC.—The term ‘NAIC’ means the Na-
tional Association of Insurance Commissioners.
150
‘‘(6) REFERENCE PREMIUM RATE.—The term
‘reference premium rate’ means, for each block of
business for a rating period in a community, the
lowest premium rate charged or which could have
been charged by the small employer carrier to small
employers in that block under a rating system for
that block of business in the community for health
plans with the same or similar coverage.
‘‘(8) SMALL EMPLOYER.—The term ‘small em-
ployer’ has the meaning given such term in section
2181(c)(1) and also includes a medium-size em-
ployer (as defined in section 2181(c)(2)).
‘‘(9) STATE.—The term ‘State’ means the 50
States and the District of Columbia.’’.
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