§ 23-86-403 — Definitions

As used in this subchapter: (1) "Benefit level" means an obligation of the health maintenance organization or insurance company under its health benefit plan. The benefit level is actuarially determined considering the copayments, deductibles, and dollar limits of the health benefit plan; (2) "Covered healthcare services" means services rendered or products sold by a healthcare provider within the scope of the healthcare provider's license which are covered by a health benefit plan. The term may include hospital, medical, surgical, dental, vision, and pharmaceutical services or products; (3) "Covered person" means any person on whose behalf a health maintenance organization is obligated to make arrangements for or pay for covered healthcare service; (4) "Health benefit plan" means the agreement between an employer, association, state, county, or municipal agency and a health maintenance organization or insurance company which defines the covered services available; (5) "Healthcare provider" means a hospital, an ambulatory surgery center, an outpatient psychiatric center, a home healthcare agency, a skilled nursing facility, or an individual licensed to render covered healthcare services; (6) "Limited network plan" means a plan that arranges for or provides reimbursement for covered healthcare services to covered persons through a limited number of healthcare providers selected and employed or contracted by the health maintenance organization; and (7) "Point-of-service plan" means a plan that provides payment of nonemergency, self-referred covered healthcare services obtained from healthcare providers who are not otherwise employed by nor under contract with the health maintenance organization.

Legislative History

Acts 1999, No. 1469, § 3.