(a) As used in this subchapter:
(1) "Third-party administrator" means a person, firm, or partnership that collects or charges premiums from or adjusts or settles claims on residents of this state in connection with life or accident and health coverage provided by a self-insured plan or a multiple employer trust or multiple employer welfare arrangement;
(2) "Pharmacy benefits manager" means an entity that administers or manages a pharmacy benefits plan or program; and
(3) "Pharmacy benefits plan or program" means a plan or program that pays for, reimburses, covers the cost of, or otherwise provides pharmacist services to individuals who reside in or are employed in this state.
(b) As used in this subchapter, "third-party administrator" includes:
(1) An administrative-services-only contract offered by insurers and health maintenance organizations; and
(2) A pharmacy benefits manager that administers or manages a pharmacy benefits plan or program that furnishes, covers the cost of, or otherwise provides for the practice of pharmacy as defined in ยง 17-92-101 under any life and accident and health coverage provided in this state by a self-insured plan, a multiple-employer trust, or a multiple-employer-welfare arrangement.
(c) As used in this subchapter, "third-party administrator" does not include the following persons:
(1) An employer, for its employees or for the employees of a subsidiary or affiliated corporation of the employer;
(2) A union, for its members;
(3) An insurer or health maintenance organization licensed to do business in this state;
(4) A creditor, for its debtors, regarding insurance covering a debt between them;
(5) A credit-card-issuing company that advances for or collects premiums or charges from its credit card holders as long as that company does not adjust or settle claims;
(6) An individual who adjusts or settles claims in the normal course of his or her practice or employment and who does not collect charges or premiums in connection with life or accident and health coverage; or
(7) An agency licensed by the Insurance Commissioner and performing duties pursuant to an agency contract with an insurer authorized to do business in this state.
Section: 23-92-202 23-92-203 23-92-204 23-92-205 23-92-206 23-92-207 23-92-208 NextLast modified: November 15, 2016