20-485. Definitions; scope

A. In this article, unless the context otherwise requires:

1. "Administrator" means any person who collects charges or premiums from or paid on behalf of, or who adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities other than any of the following:

(a) An employer on behalf of the employer's employees or the employees of one or more subsidiary or affiliated corporations of the employer.

(b) A union on behalf of its members.

(c) An insurer authorized to transact insurance in this state, including its employees and sales representatives, to the extent that it collects charges or premiums from or paid on behalf of, or adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities lawfully issued and delivered or assumed in this state and pursuant to the laws of this state or another state and for which the insurer or an affiliated insurer is presently directly liable.

(d) An insurer authorized to transact insurance in this state, including its employees and sales representatives, to the extent that it collects charges or premiums from or paid on behalf of, or adjusts or settles claims by, residents of this state in connection with life or health insurance coverage or annuities lawfully issued and delivered or assumed in this state and pursuant to the laws of this state or another state and for which an unaffiliated insurer is presently directly liable.

(e) A person other than an insurer, to the extent that the person's activities are limited to the collection of charges or premiums from or paid on behalf of, or the adjustment or settlement of claims by, residents of this state in connection with life and health insurance coverage issued and delivered or assumed by an affiliated insurer authorized to transact insurance in this state and for which the affiliated insurer is presently directly liable.

(f) A life or disability insurance producer who is licensed in this state or an employee of a licensed producer working at the direction and under the supervision of a licensed producer if the producer or the producer's employee does not adjust or settle claims.

(g) A creditor on behalf of the creditor's debtors with respect to insurance covering a debt between the creditor and its debtors.

(h) A trust and its trustees, agents and employees acting pursuant to the trust established in conformity with 29 United States Code section 186.

(i) A trust exempt from taxation under section 501(a) of the internal revenue code and its trustees and employees acting pursuant to the trust, or a custodian and its agents and employees acting pursuant to a custodian account that meets the requirements of section 401(f) of the internal revenue code.

(j) A financial institution or money transmitter that is subject to supervision or examination by federal or state banking authorities if the financial institution or money transmitter does not adjust or settle claims.

(k) A credit card issuing company that advances for and collects premiums or charges from its credit card holders who have authorized such collection, if the company does not adjust or settle claims.

(l) A person who adjusts or settles claims in the normal course of the person's practice or employment as an attorney and who does not collect charges or premiums in connection with life or health insurance coverage or annuities.

(m) An adjuster who is licensed in this state while acting in accordance with an adjuster's license.

(n) A person who acts only as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code sections 1001 through 1461).

(o) A credit card processing company that processes payments or charges for premiums if the company does not adjust or settle claims.

(p) A qualified marketplace platform on behalf of qualified marketplace contractors that have executed a written contract with the qualified marketplace platform that complies with the requirements of section 23-1603, subsection A.

(q) An employee of the group policyholder who collects or remits premiums for group life insurance, group annuities or group or blanket disability insurance if the person does not adjust claims or receive any commissions.

(r) An administrator of a trust that was established to provide life insurance, disability insurance or annuities to participants in the trust and that is also a group policyholder.  The administrator may act only as an administrator of the trust and may not adjust or settle claims.

2. "Affiliate" or "affiliated" means a person who directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with a specified person.

3. "Charges" means cost sharing requirements, including applicable coinsurance, copayments, deductibles or other amounts payable by an insured under the terms of an insurance contract.

4. "Control" means the direct or ultimate possession of the power to direct or cause the direction of the management and policies of a person whether through voting rights, contracts, other than commercial contracts for goods or nonmanagement services, or otherwise, unless the power is the result of an official position or corporate office. Control exists if any person, directly or indirectly, owns, controls, holds with the power to vote or holds proxies representing ten percent or more of the voting rights of any other person, including the right to elect or appoint the officers or directors of a nonprofit corporation.

5. "Insurer" means any person who provides life or health insurance coverage in this state or who transacts annuity business in this state.  Insurer includes an authorized insurer, hospital, medical, dental or optometric service corporation or health care services organization or any other person providing a plan of insurance subject to the laws of insurance of this state. Insurer does not include a self-insured or a self-funded employee benefit plan if regulation of that plan is preempted pursuant to section 1144(a) of the employee retirement income security act of 1974 (29 United States Code section 1144(a)) but does include an insurer who provides coverage as part of an employee benefit plan.

6. "Principal" means a person who has the authority to enter into written agreements on behalf of the administrator pursuant to section 20-485.01.

7. "Qualified marketplace contractor":

(a) Means any person or organization, including an individual, corporation, limited liability company, partnership, sole proprietor or other entity, that enters into an agreement with a qualified marketplace platform to use the qualified marketplace platform's digital platform to provide services to third-party individuals or entities seeking those services.

(b) Does not include a contractor if the services performed consist of transporting freight, sealed and closed envelopes, boxes or parcels or other sealed and closed containers for compensation.

8. "Qualified marketplace platform":

(a) Means an organization, including a corporation, limited liability company, partnership, sole proprietor or other entity, that both:

(i) Operates a digital website or digital smartphone application that facilitates the provision of services by qualified marketplace contractors to individuals or entities seeking those services.

(ii) Accepts service requests from the public only through its digital website or digital smartphone application and does not accept service requests by telephone, by fax or in person at physical retail locations.

(b) Does not include any digital website or smartphone application if the services facilitated consist of transporting freight, sealed and closed envelopes, boxes or parcels or other sealed and closed containers for compensation.

B. To the extent that an insurer is subject to subsection A, paragraph 1, subdivision (d) of this section, it shall comply with this article except sections 20-485.10 and 20-485.12.

C. This article does not apply to a person acting exclusively as a third party intermediary entity as prescribed in section 20-120.