Delaware § 102 - Definitions [For application of this section, see 79 Del. Laws, c. 172, § 6].

§ 102. Definitions [For application of this section, see 79 Del. Laws, c. 172, § 6].

As used in this part:

(1) An “alien” insurer is a foreign insurer formed under the laws of any country other than the United States of America, its states, districts, commonwealths and possessions.

(2) An “authorized” insurer is one duly authorized to transact insurance in this State by a subsisting certificate of authority issued by the Commissioner.

(3) “Balance billing” means a health-care provider’s demand that a patient pay a greater amount for a given service than the amount the individual’s insurer, managed care organization or health service corporation has paid or will pay for the service.

(4) “Commissioner” means the Insurance Commissioner of this State.

(5) “Department” means the Insurance Department of this State.

(6) A “domestic” insurer is one formed under the laws of this State.

(7) The “domicile” of an insurer means:

a. As to Canadian insurers, the province in which the insurer’s head office is located;

b. As to other alien insurers authorized to transact insurance in one or more states, as provided in § 532 (retaliatory provision) of this title;

c. As to alien insurers other than those referred to in paragraph (7)a. or b. of this section above, the country under the laws of which the insurer was formed;

d. As to all other insurers, the state under the laws of which the insurer was formed.

(8) A “foreign” insurer is one formed under the laws of any jurisdiction other than this State.

(9) “Insurance” means a contract whereby one undertakes to pay or indemnify another as to loss from certain specified contingencies or perils, called “risks,” or to pay or grant a specified amount or determinable benefit in connection with ascertainable risk contingencies or to act as surety.

(10) “Insurer” includes every person engaged as principal and as indemnitor, surety or contractor in the business of entering into contracts of insurance; provided that with respect to a corporation established under Chapter 7 of Title 5, “insurer” means an insurance department or division of such corporation (but not the corporation itself) which maintains separate books and records in the same manner and to the same extent as if it were a separately incorporated subsidiary of such corporation, with separate capital accounts, assets and liabilities.

(11) “Person” means corporations, companies, associations, firms, partnerships, societies and joint stock companies and individuals as is provided in § 302 of Title 1. In addition, “person” includes trustees of common law trusts, syndicates, organizations, statutory trusts, business trusts, attorneys-in-fact and every natural or artificial legal entity.

(12) “Religious employer” means an employer that is both of the following:

a. A church, convention, association of churches, or elementary or secondary school that is controlled, operated, or principally supported by a church or convention or association of churches.

b. Qualified as a tax-exempt organization under 26 U.S.C. § 501(c) (3).

(13) “Third-party administrator” shall mean a person, firm or entity who directly or indirectly underwrites, collects charges or premiums from, or who approves, denies, adjusts or settles claims on residents of this State, in connection with health coverage offered or provided by an insurer. A third-party administrator shall be subject to the jurisdiction of the Department of Insurance. A third-party administrator shall not include any person, firm or entity who operates a billing and/or paying service only and who does not perform any of the other functions of a third-party administrator described above. Additionally, a third-party administrator shall not include any person, firm or entity which holds a certificate of authority as an insurer, health service corporation, MCO, or HMO under this title. The Commissioner shall promulgate regulations which shall provide for the registration, licensing and regulation of third-party administrators and enforcement of applicable provisions of this title to third-party administrators. Third-party administrators doing business in this State shall pay all fees and costs for registration as provided for in this title and shall pay all costs for examination, assessments, fines and/or penalties as provided for in this title or as the Commissioner shall establish by regulation. All revenues from the application of this provision to third-party administrators shall be deposited in accordance with the provisions of § 305 of this title.

18 Del. C. 1953, §  102;  56 Del. Laws, c. 380, §  1;  67 Del. Laws, c. 223, §  17;  73 Del. Laws, c. 96, §  3;  73 Del. Laws, c. 329, §  60;  74 Del. Laws, c. 157, §  4;  79 Del. Laws, c. 172, §  4;  84 Del. Laws, c. 336, § 1;  84 Del. Laws, c. 402, § 2;