Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-67 - PORTABILITY AND RENEWABILITY › Rule 120-2-67-.03 - Definitions

Current through Rules and Regulations filed through June 27, 2024
For the purpose of this Regulation Chapter, the following
				  definitions shall apply:
(a)
				"Association" shall mean an organization as defined in O.C.G.A. §
									33-30-1(b)  and
				the Rules and Regulations of the Office of Commissioner of Insurance.
(b) "Creditable Coverage" shall mean any
				hospital, surgical, or medical expense coverage, or any combination of these
				coverages, as defined in O.C.G.A. §
									33-30-15(a)(2),
				regardless of exclusions or waivers related to such coverage, other than
				coverage under a disability income policy, a long-term care insurance policy, a
				medicare supplement policy, a health insurance policy written as part of
				workers' compensation equivalent coverage or supplemental to a liability
				policy, a specified disease policy, a credit insurance policy, a dental or
				vision benefit policy which is not an integral part of creditable coverage, a
				fixed indemnity policy, or a limited accident policy. Creditable coverage shall
				include coverage under a short-term, limited duration policy or a blanket
				accident and sickness policy which includes basic or comprehensive hospital,
				surgical, or medical expense coverage, or any combination of these coverages,
				which is (are) not exclusively contingent on accident or injury resulting from
				particular activities or limited to liability arising from such
				activities.
(c) "Employer based
				accident and sickness insurance or health benefit arrangement," as used in
				O.C.G.A. §
									33-30-15(a)(2)(B)
				 and in this Regulation Chapter, shall mean
				any insured plan or self-funded plan, regardless of whether such plan is, or
				claims to be, subject to the Employee Retirement Income Security Act of 1974,
				29 U.S.C. Section
				1001,
et seq.
(d) "Group Member" shall mean any individual
				in a group eligible for coverage under a group health insurance policy or
				contract.
(e) "Health Insurance"
				shall mean, for purposes of this Regulation Chapter, any creditable coverage as
				defined in paragraph (b) issued by an insurer on a group or individual basis,
				other than a blanket accident and sickness policy or a short-term, limited
				duration policy which limits coverage to a maximum of twelve month. Such
				blanket or short-term policies which constitute creditable coverage shall be
				considered health insurance in this Regulation Chapter only for the purposes of
				Rule 120-2-67-.12.
(f) "Health Status Related Factor" shall mean
				any of the factors described in Rule
				120-2-67-.13(a)(1).
(g) ''Insured'' shall mean:
(1) with regard to group health insurance
				coverage, any employee, group member, subscriber, enrollee or dependent covered
				under a group health insurance policy or contract; or
(2) with regard to individual health
				insurance coverage, any covered person.