21-5-407. Definitions.

21-5-407. Definitions. As used in this subchapter: (1) “Active employee” means an eligible individual currently employed by a participating entity or participating institution; (2) “Aggregate performance information” means a report or other means of communication about the measurement of accomplishment of the execution of certain tasks, achievement of certain results, or occurrence of certain events related to all patients or to a class or group of patients identifiable by certain criteria; (3) “Consumer-driven health insurance plan option” means a qualified high deductible health plan option with high out-of-pocket costs adopted by the State and Public School Life and Health Insurance Board that is consistent with guidance provided by the Internal Revenue Service for health savings accounts, annual contribution limits, and high deductible health insurance plans under Revenue Procedure 2013-25 and subsequent guidance; (4)(A) “Dependent” means a participant's: (i) Natural child, stepchild, or adopted child who is eligible for coverage under the State and Public School Life and Health Insurance Program; and (ii) Spouse who is eligible for coverage under the program. (B) Beginning in the 2015 plan year, “dependent” does not include: (i) An individual who is legally separated or divorced from the participant; or (ii) A participant’s spouse if the spouse is offered healthcare coverage, other than the program, through a separate employer-funded or employee-funded benefit plan that provides healthcare coverage of essential health benefits as provided in 42 U.S.C. § 18022, as existing on January 1, 2013; (5)(A) “Eligible inactive retiree” means a former member of the General Assembly or a state-elected constitutional officer who has served a sufficient number of years of credited service to be eligible for retirement benefits but who has not yet reached retirement age. (B) An eligible inactive retiree who enrolls in the program shall pay the entire premium cost of the plan option selected under the program as set by the board; (6) “Health savings account” means an account established by a participant under a medical care savings account program to pay the eligible medical expenses of a participant and the dependents of the participant; (7) “High deductible” means the deductible limitations for a qualified high deductible health plan under the Internal Revenue Service, as adjusted annually for inflation based upon the board's calculation using the formula provided by 26 U.S.C. § 1(f)(3)–(6); (8) “Participant” means an individual or an individual's dependent who is enrolled in a plan option offered under the program and continues to be eligible for participation in the program; (9) “Participating entity” means an organization authorized to participate in the program, including without limitation a state agency, school district, public charter school, or education service cooperative; (10) “Participating institution” means a two-year or four-year college that is participating in the program; (11) “Prepayment” means collection of medical or life insurance premiums or both medical and life insurance premiums from the employee and employer one (1) month in advance; (12) “Public school employee” means an employee of a school district or public charter school; (13) “Qualifying event” means a change in an employee's personal life that may impact his or her eligibility or a dependent's eligibility for benefits, as defined by Internal Revenue Service guidelines; (14) “Quality-of-care information” means the contents of medical records, member claims, patient surveys, pharmacy data, lab data, and other records of or reports about systems, networks, hospitals, and clinical providers to be gathered for assessment of the quality and costs of health care provided by systems, networks, hospitals, and clinical providers; (15) “Quality performance indicator” means a specific inquiry or standard that when applied to quality-of-care information reveals a quantifiable measure of success or failure in system, network, hospital, or clinical provider care; (16) “Retiree” means a retired employee who is eligible under § 21-5-411; (17) “Rural school district” means a school district or a public charter school that has an average daily membership of one thousand (1,000) students or less; (18) “State employee” means an employee of a state agency, board, or commission whose position is budgeted for by the General Assembly; and (19) “Vendor” means a corporation, partnership, or other organization that is: (A) Licensed to do business and in good standing with the State of Arkansas; and (B) Lawfully engaged in administering employer-funded or employee-funded benefit plans for employer groups in consideration of an administration fee.