2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 43 - Health Care › Article 1 - Wyoming Health Insurance Pool Act › Section 26-43-101 - Definitions.

26-43-101. Definitions.
(a) As used in this act:
(i) "Account" means the account provided by W.S. 26-43-112;
(ii) "Administrator" means the insurer, insurers or third party administrator or administrators selected pursuant to W.S. 26-43-104(a) to administer the pool;
(iii) "Board" means the board of directors of the pool;
(iv) "Commissioner" means the insurance commissioner;
(v) "Department" means the insurance department;
(vi) "Health insurance" means any public health benefit plan, private health benefit plan, hospital and medical expense incurred policy, Medicare supplement policy, nonprofit health care service plan contract and health maintenance organization subscriber contract. The term does not include any hospital or medical service plan which by contract or product design is intended to provide coverage for six (6) months or less, fixed indemnity, limited benefit or credit insurance, coverage issued as a supplement to liability insurance, insurance arising from a workers' compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance;
(vii) "Health maintenance organization" means as defined by W.S. 26-34-102;
(viii) "Hospital" means a facility licensed as a hospital by the department of health;
(ix) "Insurance arrangement" means any plan, program, contract or any other arrangement under which one (1) or more employers, unions or other organizations provide to their employees or members, either directly or indirectly through a trust or third party administrator, health care services or benefits other than through an insurer. For purposes of assessments under this act "insurance arrangement" does not include any plan, program, contract or other arrangement under which the state of Wyoming, its political subdivisions or school districts provide health care services or benefits pursuant to the authority granted under W.S. 9-3-201;
(x) "Insured" means any individual resident of this state who is eligible to receive benefits from any insurer or insurance arrangement;
(xi) "Insurer" means any insurance company authorized to transact disability insurance business in this state, Medicare supplement insurance issuer, health maintenance organization or health service plan operation under W.S. 26-22-301;
(xii) "Medicare" means coverage under both Part A and B of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq.;
(xiii) "Member" means all insurers and insurance arrangements participating in the pool;
(xiv) "Plan of operation" means the plan of operation of the pool, including articles, bylaws and operating rules adopted by the board pursuant to W.S. 26-43-102;
(xv) "Pool" means the Wyoming health insurance pool created by W.S. 26-43-102;
(xvi) Repealed by Laws 2019, ch. 16, 2.
(xvii) "Creditable coverage" means, with respect to an individual, coverage of the individual provided under any private health benefit plan or public health benefit plan;
(xviii) "Federally defined eligible individual" means an individual:
(A) For whom, as of the date on which the individual seeks coverage under this act, the aggregate of the periods of creditable coverage, is eighteen (18) or more months;
(B) Whose most recent prior creditable coverage was under a group private or public health benefit plan;
(C) Who is not eligible for coverage under a group health plan, part A or part B of Medicare or Medicaid, and who does not have other health insurance coverage;
(D) With respect to whom the most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;
(E) Who, if offered the option of continuation coverage under a COBRA continuation provision or under a similar state program, elected such coverage; and
(F) Who has exhausted such continuation coverage under such provision or program, if the individual elected the continuation coverage described in subparagraph (E) of this paragraph.
(xix) "Eligibility level" means a percentage of the federal poverty guideline for level of coverage under the plan of operation;
(xx) "This act" means W.S. 26-43-101 through 26-43-114.