As used in this subchapter, unless the context otherwise requires:
1. "Basic benefit coverage" means basic health care services rendered by health professionals licensed pursuant to state law together with hospital expenses.
2. "Basic health care services" means services which an enrollee might reasonably require in order to be maintained in good health, including at a minimum, emergency care, inpatient hospital and physician care, and outpatient medical services rendered within or outside of a hospital.
3. "Commissioner" means the commissioner of insurance.
4. "Eligible dependent" means an enrolled dependent of a subscriber entitled to coverage under a basic benefit coverage policy or subscription contract.
5. "Group" means a group composed of eligible employees of a single employer and their dependents. A group shall not have more than twenty-five full-time equivalent employees in number. Employees may not be segregated by division, job responsibilities, employment status, employment location, or any other rationale. For purposes of this subchapter, group size will be determined at the time of application for the basic benefit coverage policy, and on each anniversary of the date of issue of the basic benefit coverage policy. Carriers shall confirm the size of groups by certification of the employer which certification shall be maintained in the carrier's file.
6. "Insurer" means any insurer issuing a group accident and sickness insurance policy on an expense incurred basis and any group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A, or any group health maintenance organization contract under chapter 514B.
7. "Policy" means the entire contract between the insurer and the insured, including the policy riders, endorsements, and the application, if attached, and includes individual subscriber contracts issued under chapter 514B.
8. "Subscriber" means an enrolled eligible employee with coverage under a basic benefit coverage policy.
91 Acts, ch 244, §11
CS91, § 514H.1
93 Acts, ch 80, § 16, 20
CS93, § 513B.31
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