Health Net 2009 Annual Report Download - page 481

“Business” shall mean HN Life’s business in the Applicable States relating to the Membership.
“Buyer” shall have the meaning ascribed to it in the first paragraph.
“Chosen Courts” shall have the meaning ascribed to it in Section 8.6.
“Commissions” means all commissions, expense allowances, benefit credits, service fees, payments and other fees and
compensation payable to Brokers/Consultants with respect to the HN Life Health Plan Contracts.
“Communication Plan” shall have the meaning ascribed to it in Section 3.1.
“Effective Date” shall have the meaning ascribed to it in the first paragraph.
“Enrollment Report” shall have the meaning ascribed to it in Section 2.4(a).
“Excluded Business” shall mean any and all of HN Life’s membership, assets, books and records, business, contracts or business
process outsourcing arrangements, other than HN Life Health Plan Contracts with HN Life Employer Groups.
“Fully Insured Contract” shall mean a contract for the provision of services for a broad spectrum of medical health benefits to an
individual or group under which the risk of loss is borne by the insurer (including contracts pursuant to which the insured bears a
portion of the risk through deductibles, co-payments and other Member cost-sharing features).
“HN Life” shall have the meaning ascribed to it in the first paragraph.
“HN Life Employer Groups” shall mean any or all Employer Groups sitused in the Applicable States which contract to provide
health benefits on behalf of their eligible employees, members or beneficiaries who are enrolled pursuant to HN Life Health Plan
Contracts, consistent with HN Life’s past practices, as of or following the Effective Date.
“HN Life Health Plan Contracts” shall mean (a) the commercial group health care benefit insurance contracts to which HN Life
is a party and (i) which involve the arrangement, delivery, provision or payment of health care benefits to Members, (ii) which were
entered into pursuant to a license maintained by HN Life, and (iii) in which the risk of loss is borne by HN Life (including contracts
pursuant to which the insured bears a portion of the risk of loss through deductibles, co-payments and other Member cost-sharing
features); and (b) commercial group health care benefit contracts between HN Life, as a third party administrator, and an Employer
Group in which the economic risk of medical claims is borne by the health and welfare benefit plan or trust sponsored or established
by the Employer Group.
“Law” means any applicable federal, state or local statute, law (including common law), ordinance, regulation, rule, ruling,
order, writ, injunction, decree, regulatory settlement or stipulation of or by any Governmental Entity, including all applicable health
care and insurance laws.
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