(a) As used in this article:
(1) "Association" means the West Virginia health maintenance organization guaranty association created by section six of this article.
(2) "Board of directors" means the board of directors of the association, formed pursuant to section seven of this article.
(3) "Commissioner" means the commissioner of insurance or his designee.
(4) "Contractual obligation(s)" means any and all obligations to covered individuals under a covered health care policy.
(5) "Covered health care policy" means any policy, certificate or contract issued by a health maintenance organization for health care services.
(6) "Covered individual" means a subscriber, enrollee or member of an insolvent health maintenance organization who is a resident of this state, but shall not include an individual enrolled in such health maintenance organization under this state's medicaid program.
(7) "Date of insolvency" means the date upon which an order of liquidation is entered by a court of competent jurisdiction, even if such order has not become final by the exhaustion of appellate reviews, or if the health maintenance organization is incorporated in another state, the date upon which the commissioner enters an order revoking the health maintenance organization's certificate ofauthority as described in subdivision (9) of this subsection.
(8) "Health maintenance organization" means a health maintenance organization possessing a valid certificate of authority issued by the commissioner pursuant to article twenty-five-a of this chapter, but shall not include any health maintenance organization with one hundred percent of its enrollees participating in the health maintenance organization under this state's medicaid program or any health maintenance organization which is not required, as a condition of being allowed to transact business as a health maintenance organization in this state, to maintain at least two million dollars of either surplus or of surplus and fully paid in capital stock.
(9) "Insolvent health maintenance organization" or "insolvent" means a health maintenance organization against which an order of liquidation has been entered by a court of competent jurisdiction, even if such order has not become final by the exhaustion of appellate reviews, or a health maintenance organization which is incorporated in another state and which has had its certificate of authority revoked by an order of the commissioner containing a finding by the commissioner that the health maintenance organization either is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to its enrollees, or is in a hazardous financial condition.
(10) "Person" means any individual, corporation, partnership, association, or voluntary organization, or any other legal entity.
(b) Words and phrases which are not defined in this section, but are defined in article twenty-five-a of this chapter, shall have the meanings established in that article unless the context in which a word or phrase appears clearly requires otherwise.
Note: WV Code updated with legislation passed through the 2015 Regular Session
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