Section 45-06-14-01 - Definitions1. "Board" means a multiple employer welfare arrangement's board of trustees.2. "Bylaws" means the statements and organizational documents adopted by a multiple employer welfare arrangement that prescribe its purpose, government, and administration.3. "Commissioner" means the insurance commissioner.4. "Coverage" means the right of a covered person or entity to benefits or indemnification provided directly or indirectly by a multiple employer welfare arrangement, by virtue of the coverage document.5. "Coverage document" means the document specifying the characteristics and duration of coverage provided through a multiple employer welfare arrangement. Characteristics of coverage include the kind of loss or benefit that the multiple employer welfare arrangement will reimburse, subject to specific exclusions, limitations, or deductibles.6. "Days" means calendar days.7. "Employee welfare benefit plan" means an employee welfare benefit plan as defined by 29 U.S.C. section 1002.8. "Financial administrator" means an entity employing persons trained and experienced in money management and investments, and possessing no less than five years' experience as an organization in money management and investments with demonstrated competence.9. "Fully insured" means that for the health care benefits or coverage provided or offered by or through a multiple employer welfare arrangement: a. An admitted insurer is directly obligated by contract to each participant to provide all of the coverage under the plan or arrangement; andb. The liability and responsibility of the admitted insurer to provide covered services or to pay benefits is not contingent, and is provided directly to the individual employee, member, or dependent.10. "Fund year" means a multiple employer welfare arrangement's twelve-month fiscal year. 11. "Multiple employer welfare arrangement" means a multiple employer welfare arrangement as defined by 29 U.S.C. section 1002.12. "Premium" means the amount charged by the multiple employer welfare arrangement for health coverage. "Premium" does not include assessments or penalties.13. "Professional employer organization" means an arrangement, under contract or otherwise, whereby one business or entity represents it co-employs or leases workers to another business or entity for an ongoing and extended, rather than a temporary or project-specific, relationship.14. "Runoff multiple employer welfare arrangement" means a multiple employer welfare arrangement that no longer has authority to self-fund but that continues to exist for the purpose of paying claims, preparing reports, and administering transactions associated with the period when the multiple employer welfare arrangement provided coverage. 15. "Self-funded multiple employer welfare arrangement" means a multiple employer welfare arrangement that does not provide for payment of benefits under the arrangement solely through a policy or policies of insurance issued by one or more insurance companies with a certificate of authority under North Dakota Century Code title 26.1.16. "Service company" means an entity licensed under North Dakota Century Code chapter 26.1-27 as an administrator or an entity licensed under North Dakota Century Code title 26.1 as an insurance company, health maintenance organization, or nonprofit health service corporation.17. "Sponsoring association" means a group that sponsors or organizes a multiple employer welfare arrangement. A multiple employer welfare arrangement may have more than one sponsoring association.18. "Surplus" means a multiple employer welfare arrangement's total assets minus total liabilities. "Surplus" includes paid-in capital and retained earnings. The amount of a multiple employer welfare arrangement's surplus is determined according to the instructions provided for a multiple employer welfare arrangement's financial statements.N.D. Admin Code 45-06-14-01
Effective January 1, 2007.Amended by Administrative Rules Supplement 2017-364, April 2017, effective 4/1/2017.General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-01-07.4, 26.1-07.1