Sec. 14.35.18.02. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Common law employee” has the meaning stated in 20 CFR §404.1007.

(2) “Date of enrollment’’ means the date of enrollment of an individual covered under a group health plan or, if earlier, the first day of the waiting period for such enrollment.

(3) “Employer group health insurance coverage” means health coverage offered by an employer to an employee and the employee’s dependents, if eligible, under:

(a) Government health coverage, such as the Federal Employees Health Benefit program;

(b) Health coverage offered in the small or large group market by an employer within a state; or

(c) Grandfathered health coverage offered by an employer in a group market.

(4) “Full-time employee” means a common law employee working on average, at least 30 hours per week.

(5) “Independent contractor” means a 1099 employee working 30 or more hours per week.

(6) “Member” means any person enrolled in a health benefit plan.

(7) “Part-time employee” means a common law employee working fewer than 30 hours per week, or seasonal worker working more than 120 days per year.

(8) “Participation rate” means the percentage of eligible employees electing to participate in a health benefit plan out of all eligible employees.

(9) “Participation requirement” means a policy provision, or a carrier’s underwriting guideline if there is no such provision, which requires that a group attain a certain participation rate in order for a carrier to accept the group for enrollment in the plan.

(10) “Qualified employee’’ means an employee who:

(a) Works on a full-time basis with a normal work week of thirty or more hours, but does not include an employee who works on a temporary or substitute basis; and

(b) Is hired to work for a period of not less than 5 months.

(11) “Qualified employer” means a small employer that elects to make its full-time employees and, at the option of the employer, some or all of its part-time employees eligible for one or more qualified health plans offered through the SHOP Exchange, provided that the employer:

(a) Has its principal place of business in the State and elects to provide coverage through the SHOP Exchange to all of its eligible employees, wherever employed; or

(b) Elects to provide coverage through the SHOP Exchange to all of its eligible employees who are principally employed in the State.

(12) “Rescission” means a cancellation or discontinuance of coverage that has retroactive effect.

(13) “Waiting period” means the period of time that must pass before coverage for a qualified employee who is otherwise eligible to enroll under the terms of a small group health plan can become effective.