Section 230-RICR-20-30-15.3 - DefinitionsA. As used in this regulation: 1. "Actuarial value" means the level of coverage provided by an issuer of a health insurance plan's benefits, as further defined in 42 U.S.C. § 18022(d) and regulations adopted thereunder.2. "Commissioner" means the Commissioner of the Office of the Health Insurance Commissioner.3. "Essential health benefits" means health insurance plan coverage of the benefits required by 42 U.S.C § 18022(b), including if applicable any benchmark plan designated by the Commissioner on behalf of the Governor;4. "Exchange" means the Rhode Island Health Benefits Exchange established by Executive Order No. 11-09, issued on September 19, 2011.5. "Health insurance issuer" means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization licensed under R.I. Gen. Laws Chapter 27-41, a non-profit hospital service corporation organized under R.I. Gen. Laws Chapter 27-19, a non-profit medical service corporation organized under R.I. Gen. Laws Chapter 27-20, a non-profit dental service corporation organized under R.I. Gen. Laws Chapter 27-20.1, a non-profit optometric service corporation organized under R.I. Gen. Laws Chapter 27-20.2, a domestic insurance company subject to R.I. Gen. Laws Chapter 27-1 that offers or provides health insurance coverage in the state, and a foreign insurance company subject to R.I. Gen. Laws Chapter 27-2 that offers or providers health insurance coverage in the state. 6. "Health insurance plan" means: a. A policy, contract, certificate or other evidence of agreement to provide "health insurance coverage," as defined in R.I. Gen. Laws §§ 27-18.5-2(8) and 27-18.6-2(15), or to provide a "health benefit plan," as defined in R.I. Gen. Laws § 27-50-3(t), including but not limited to an individual health insurance plan, a small group health insurance plan, a large group market health insurance plan, a plan of Medicare Supplemental insurance, and a plan of dental insurance. The term shall include a qualified health plan offered on the Exchange, and a qualified health plan offered on the Exchange by the Small Business Health Options Program. The terms "individual health insurance plan", and "small group health insurance plan" do not include a Medicare Supplement insurance plan or a dental insurance plan.b. The term shall include a health insurance plan in which the certificate or other evidence of coverage is offered, issued, delivered or renewed to an individual resident in this state, or to the employees or members and their dependents of a small group or employer located in this state where the health insurance plan is issued or delivered outside of this state, and the plan offers or provides such coverage through a trust association or other intermediary.7. "Office of the Health Insurance Commissioner" or "Office" means the agency established pursuant to R.I. Gen. Laws § 42-14.5-1 et seq.8. "Qualified health plan" means a health insurance plan that has been approved by the Office, certified by the Exchange, and with respect to which the Issuer has been licensed by the Office and certified by the Exchange, in accordance with 42 U.S.C. Chapter 157, Subchapter III (§§18021 through 18063) and regulations adopted thereunder.9. "Risk adjustment and reinsurance" means the programs authorized by 42 U.S.C. § 18061 et seq.10. "SERFF" means the System for Electronic Rate and Form Filing administered under the auspices of the National Association of Insurance Commissioners.11. "Small Business Health Option Program" or "SHOP" means the program authorized by 42 U.S.C § 18031(b)(1)(B).230 R.I. Code R. 230-RICR-20-30-15.3