Section 284-91-110 - DefinitionsThe definitions in this section apply throughout this chapter.
(1) "Accounting year" means a 12-month period determined by the board for purposes of recordkeeping and accounting. The first accounting year may be more or less than 12 months and, from time to time in subsequent years, the board may order an accounting year of other than 12 months as may be required for orderly management and accounting of the pool.(2) "Administrator" means the entity chosen by the board to administer the pool under RCW 48.41.080.(3) "Board" means the board of directors of the pool.(4) "Commissioner" means the insurance commissioner.(5) "Health care provider" means any physician, facility, or health care professional, who is licensed in Washington state and entitled to reimbursement for health care services.(6) "Health care services" means services for the purpose of preventing, alleviating, curing, or healing human illness or injury.(7) "Health carrier" or "carrier" has the same meaning as in WAC 284-43-0160.(8)(a) "Health coverage" means any group or individual disability insurance policy, health care service contract, and health maintenance agreement, except those contracts entered into for the provision of medicare.(b) "Health coverage" does not include: (i) Short-term care, long-term care, dental, vision, accident, fixed indemnity, disability income contracts, limited benefit or credit insurance;(ii) Coverage issued as a supplement to liability insurance;(iii) Insurance arising out of the worker's compensation or similar law;(iv) Automobile medical payment insurance; or(v) 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.(9) "Health plan" means any arrangement by which persons, including dependents or spouses, covered or making application to be covered under this pool, have access to hospital and medical benefits or reimbursement.(a) This includes any: "Health coverage," as defined under this section; uninsured arrangements of group or group-type contracts, including employer self-insured, cost-plus, or other benefit methodologies not involving insurance or not governed by Title 48 RCW; coverage under group-type contracts which are not available to the general public and can be obtained only because of connection with a particular organization or group; and coverage by medicare or other governmental benefits.(b) "Health plan" excludes the types of insurance excluded under the definition of "health coverage" in this section.(10)(a) "Member" means:(i) Any commercial health carrier which provides disability insurance or stop loss insurance, any health care service contractor, any health maintenance organization licensed under Title 48 RCW, and any self-funded multiple employer welfare arrangement as defined in RCW 48.125.-010;(ii) The Washington state health care authority as issuer of the state uniform medical plan; or(iii) When authorized by federal law, employers and other entities, including self-insured employers, other self-funding entities, and employee welfare benefit plans that provide health plan benefits in this state.(b) "Member" does not include any carrier, health care service contractor, or health maintenance organization whose products are exclusively dental products or those products excluded from the definition of "health coverage" in this section.(11) "Plan of operation" means the pool, including articles, bylaws, and operating rules, adopted by the board pursuant to RCW 48.41.050.(12) "Pool" means the Washington state health insurance pool.Wash. Admin. Code § 284-91-110
Adopted by WSR 21-23-067, Filed 11/12/2021, effective 12/13/2021