20-485. Definitions; scope
A. In this article, unless the context otherwise requires:
1. " Administrator" means any person who collects charges or premiums from or paid on behalf of, or who adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities other than any of the following:
(a) An employer on behalf of such employer's employees or the employees of one or more subsidiary or affiliated corporations of such employer.
(b) A union on behalf of its members.
(c) An insurer authorized to transact insurance in this state, including its employees and sales representatives, to the extent that it collects charges or premiums from or paid on behalf of, or adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities lawfully issued and delivered or assumed in this state and pursuant to the laws of this state or another state and for which the insurer or an affiliated insurer is presently directly liable.
(d) An insurer authorized to transact insurance in this state, including its employees and sales representatives, to the extent that it collects charges or premiums from or paid on behalf of, or adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities lawfully issued and delivered or assumed in this state and pursuant to the laws of this state or another state and for which an unaffiliated insurer is presently directly liable.
(e) A person other than an insurer, to the extent that the person's activities are limited to the collection of charges or premiums from or paid on behalf of, or the adjustment or settlement of claims by, residents of this state in connection with life and health insurance coverage issued and delivered or assumed by an affiliated insurer authorized to transact insurance in this state and for which the affiliated insurer is presently directly liable.
(f) A life or disability insurance producer who is licensed in this state and whose activities are limited exclusively to the sale of insurance.
(g) A creditor on behalf of such creditor's debtors with respect to insurance covering a debt between the creditor and its debtors.
(h) A trust and its trustees, agents and employees acting pursuant to such trust established in conformity with 29 United States Code section 186.
(i) A trust exempt from taxation under section 501(a) of the internal revenue code and its trustees and employees acting pursuant to such trust, or a custodian and its agents and employees acting pursuant to a custodian account which meets the requirements of section 401(f) of the internal revenue code.
(j) A financial institution which is subject to supervision or examination by federal or state banking authorities.
(k) A credit card issuing company which advances for and collects premiums or charges from its credit card holders who have authorized such collection, if such company does not adjust or settle claims.
(l) A person who adjusts or settles claims in the normal course of such person's practice or employment as an attorney and who does not collect charges or premiums in connection with life or health insurance coverage or annuities.
(m) An adjuster licensed in this state while acting in accordance with an adjuster's license.
(n) A person who acts only as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code sections 1001 through 1461).
2. " Affiliate" or " affiliated" means a person who directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with a specified person.
3. " Control" means the direct or ultimate possession of the power to direct or cause the direction of the management and policies of a person whether through voting rights, contracts, other than commercial contracts for goods or nonmanagement services, or otherwise, unless the power is the result of an official position or corporate office. Control exists if any person, directly or indirectly, owns, controls, holds with the power to vote or holds proxies representing ten per cent or more of the voting rights of any other person, including the right to elect or appoint the officers or directors of a nonprofit corporation.
4. " Insurer" means any person who provides life or health insurance coverage in this state or who transacts annuity business in this state. Insurer includes an authorized insurer, hospital, medical, dental or optometric service corporation or health care services organization or any other person providing a plan of insurance subject to the laws of insurance of this state. Insurer does not include a self-insured or a self-funded employee benefit plan if regulation of that plan is preempted pursuant to section 1144(a) of the employee retirement income security act of 1974 (29 United States Code section 1144(a)) but does include an insurer who provides coverage as part of an employee benefit plan.
5. " Principal" means a person who has the authority to enter into written agreements on behalf of the administrator pursuant to section 20-485.01.
B. To the extent that an insurer is subject to subsection A, paragraph 1, subdivision (d) of this section, it shall comply with this article except sections 20-485.10 and 20-485.12.
C. This article does not apply to a person acting exclusively as a third party intermediary entity as prescribed in section 20-120.
Section: Previous 20-481.26 20-481.27 20-481.28 20-481.29 20-481.30 20-481.31 20-481.32 20-485 20-485.01 20-485.02 20-485.03 20-485.04 20-485.05 20-485.06 20-485.07 NextLast modified: October 13, 2016