Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 71 - Multiple Employer Welfare Arrangements (MEWAs) › Section 71-3 - Definitions

Current through July 13, 2024
for purposes of this Chapter are as follows:
(a) "Administrative Services Only (ASO)
				Contract" means an arrangement in which an employer hires a third party to
				deliver administrative services to the employer such as claims processing and
				billing; the employer bears the risk for claims.
(b) "Carrier" shall be as defined in W.S.
				§
									
										26-19-302(a)(v).
(c) "Commissioner" means the Wyoming
				Insurance Commissioner.
(d)
				"Department" means the Wyoming Department of Insurance.
(e) "Employee Welfare Benefit Plan," as used
				in this Chapter, has the same meaning as that contained in
				29
				U.S.C. §
										1002(1).
(f) "Employer" for purposes of this Chapter
				means a group of employers that will be treated as the "employer" sponsor of a
				single multiple-employer employee welfare benefit plan, or "group health plan"
				as those terms are defined in Title I of the Employee Retirement Income
				Security Act (ERISA) of 1974,
				29 U.S.C. §
										1001
et seq
., as
				amended.
(g) "Fully Insured Health
				Benefit Plan" means a health benefit plan in which the MEWA purchases health
				coverage from a state-licensed insurer and the insurer assumes the risk of
				paying the medical claims of the MEWA's enrolled members.
(h) "Health Benefit Plan" means any hospital
				or medical policy or certificate, major medical expense insurance, hospital or
				medical service plan contract or health maintenance organization subscriber
				contract. "Health benefit plan" does not include accident-only, credit, dental,
				vision, Medicare supplement, long-term care or disability income insurance,
				coverage issued as a supplement to liability insurance, worker's compensation
				or similar insurance or automobile medical-payment insurance, nor does it
				include policies or certificates of specified disease, hospital confinement
				indemnity or limited benefit health insurance if the carrier offering the
				policies or certificates certifies to the commissioner that policies or
				certificates described in this paragraph are being offered and marketed as
				supplemental health insurance and not as a substitute for hospital or medical
				expense insurance or major medical expense insurance as defined in W.S. §
									
										26-19-302(a)(xii).
(i) "Insurer" shall be as defined in W.S.
				§
									
										26-1-102(a)(xvi).
(j) "Member" means any employee or former
				employee of an employer, or any current or former participant of an employee
				organization, or eligible dependent of an employee who is or may become
				eligible to receive a benefit of any type from an employee welfare benefit plan
				which covers employees of such employer or members of such organization, or
				whose beneficiaries may be eligible to receive any such benefit.
(k) "Multiple Employer Welfare Arrangement"
				or "MEWA", for purposes of this Chapter, shall be as defined in W.S. §
									
										26-1-102(a)(xliii).
(l) "Qualified Actuary" means an individual
				who is qualified to sign the applicable statement of actuarial opinion in
				accordance with the American Academy of Actuaries qualification standards for
				actuaries signing the statements and who meets the requirements specified in
				the valuation manual.
(m)
				"Self-Insured Health Benefit Plan" means a health benefit plan that is provided
				directly by the MEWA for its members by providing funds to pay for a health
				benefit plan directly and the MEWA bearing the risk for covering medical
				claims.
(n) "Third Party
				Administrator" or "TPA" means a person who directly or indirectly underwrites,
				collects, charges collateral or premiums from, or adjusts or settles claims on
				residents of this state, in connection with life, annuity, health, or stop-loss
				coverage offered or provided by a MEWA.