§ 6403 — Definitions

As used in this chapter, unless the context clearly indicates a different meaning, the following words and phrases shall have the meaning ascribed to them in this section:

(1) “Basic health services” means a range of services including at least the following: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive services and out-of-area coverage.

(2) “Certified managed care organization” means a managed care organization which has been issued a certificate of authority under this title.

(3) “Department” means the Delaware Department of Insurance.

(4) “Health-care services” means any service included in the furnishing to any individual of medical or dental care, or hospitalization or incidental to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing or healing human illness, injury or physical disability.

(5) “Managed care organization” means a public or private organization, organized under the laws of any state, which:

a. Makes health-care services, including at least the basic health services defined in paragraph (1) of this section above, available to enrolled participants;

b. Is primarily compensated (except for copayment) for the provision of basic health-care services to enrolled participants on a predetermined periodic rate basis; and

c. Provides physicians’ services.

The organization may also arrange for health-care services on a prepayment or other financial basis.

Legislative History

63 Del. Laws, c. 382, § 1 ; 66 Del. Laws, c. 124, §§ 1, 3-5 ; 71 Del. Laws, c. 229, §§ 1, 3 ; 72 Del. Laws, c. 441, § 1 ; 75 Del. Laws, c. 362, § 2