Effective - 28 Aug 2018, 2 histories
376.718. Definitions. — As used in sections 376.715 to 376.758, the following terms shall mean:
(1) "Account", any of the accounts created under section 376.720;
(2) "Association", the Missouri life and health insurance guaranty association created under section 376.720;
(3) "Benefit plan", a specific employee, union, or association of natural persons benefit plan;
(4) "Contractual obligation", any obligation under a policy or contract or certificate under a group policy or contract, or portion thereof for which coverage is provided under the provisions of section 376.717;
(5) "Covered contract" or "covered policy", any policy or contract or portion of a policy or contract for which coverage is provided under the provisions of section 376.717;
(6) "Director", the director of the department of commerce and insurance of this state;
(7) "Extra-contractual claims", includes but is not limited to claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys fees and costs;
(8) "Health benefit plan", any hospital or medical expense policy or certificate, health maintenance organization subscriber contract, or any other similar health contract. Health benefit plan does not include:
(a) Accident-only insurance;
(b) Credit insurance;
(c) Dental-only insurance;
(d) Vision-only insurance;
(e) Medicare supplement insurance;
(f) Benefits for long-term care, home health care, community-based care, or any combination thereof;
(g) Disability income insurance;
(h) Coverage for on-site medical clinics; or
(i) Specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates;
(9) "Impaired insurer", a member insurer which, after August 13, 1988, is not an insolvent insurer, and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction;
(10) "Insolvent insurer", a member insurer which, after August 13, 1988, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency;
(11) "Member insurer", any insurer, health maintenance organization, or health services corporation licensed or which holds a certificate of authority to transact in this state any kind of insurance or health maintenance organization business for which coverage is provided under section 376.717, and includes any insurer or health maintenance organization whose license or certificate of authority in this state may have been suspended, revoked, not renewed or voluntarily withdrawn, but does not include:
(a) A fraternal benefit society;
(b) A mandatory state pooling plan;
(c) A mutual assessment company or any entity that operates on an assessment basis;
(d) An insurance exchange;
(e) An organization that issues qualified charitable gift annuities, as defined in section 352.500, and does not hold a certificate or license to transact insurance business; or
(f) Any entity similar to any of the entities listed in paragraphs (a) to (e) of this subdivision;
(12) "Moody's Corporate Bond Yield Average", the monthly average corporates as published by Moody's Investors Service, Inc., or any successor thereto;
(13) "Owner", "policyholder", "policy owner", or "contract owner", the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. Owner, contract owner, policyholder, and policy owner shall not include persons with a mere beneficial interest in a policy or contract;
(14) "Person", any individual, corporation, partnership, association or voluntary organization;
(15) "Premiums", amounts received on covered policies or contracts, less premiums, considerations and deposits returned thereon, and less dividends and experience credits thereon. The term does not include any amounts received for any policies or contracts or for the portions of any policies or contracts for which coverage is not provided under subsection 3 of section 376.717, except that assessable premium shall not be reduced on account of subdivision (3) of subsection 3 of section 376.717 relating to interest limitations and subdivision (2) of subsection 4 of section 376.717 relating to limitations with respect to any one life, any one participant, and any one policy or contract holder. Premiums shall not include:
(a) Premiums on an unallocated annuity contract; or
(b) With respect to multiple nongroup policies of life insurance owned by one owner, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, premiums in excess of five million dollars with respect to such policies or contracts, regardless of the number of policies or contracts held by the owner;
(16) "Principal place of business", for a person other than a natural person, the single state in which the natural persons who establish policy for the direction, control, and coordination of the operations of the entity as a whole primarily exercise that function, determined by the association in its reasonable judgment by considering the following factors:
(a) The state in which the primary executive and administrative headquarters of the entity is located;
(b) The state in which the principal office of the chief executive officer of the entity is located;
(c) The state in which the board of directors, or similar governing person or persons, of the entity conducts the majority of its meetings;
(d) The state in which the executive or management committee of the board of directors, or similar governing person or persons, of the entity conducts the majority of its meetings; and
(e) The state from which the management of the overall operations of the entity is directed;
(17) "Receivership court", the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the insurer;
(18) "Resident", any person who resides in this state on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer, whichever first occurs, and to whom a contractual obligation is owed. A person may be a resident of only one state, which in the case of a person other than a natural person shall be its principal place of business. Citizens of the United States that are either residents of foreign countries or residents of the United States' possessions, territories, or protectorates that do not have an association similar to the association created under sections 376.715 to 376.758 shall be deemed residents of the state of domicile of the member insurer that issued the policies or contracts;
(19) "State", a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate;
(20) "Structure settlement annuity", an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant;
(21) "Supplemental contract", any written agreement entered into for the distribution of proceeds under a life, health, or annuity policy or contract;
(22) "Unallocated annuity contract", any annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under such contract or certificate.
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(L. 1988 S.B. 430 § 4, A.L. 2010 S.B. 583, A.L. 2018 H.B. 1690)