§ 42-62-4. Definitions.
For the purposes of this chapter:
(1) "Benefit� or "health benefit� means a health service financed for a person by a third
party such as an insurer or the state.
(2) "Employee� means any person who has entered into the employment of or works under
contract of service or apprenticeship with any employer. It shall not include a person
who has been employed for less than thirty (30) days by the person's employer, nor
shall it include a person who works less than an average of thirty (30) hours per
week. For the purposes of this chapter, the term "employee� shall mean a person employed
by an employer as defined in subsection (3). Except as otherwise provided in this
chapter, the terms "employee� and "employer� are to be defined according to the rules
and regulations of the department of labor and training.
(3) "Employer� means any person, partnership, association, trust, estate, corporation,
whether foreign or domestic, or the legal representative, trustee in bankruptcy, receiver
or trustee, thereof, or the legal representative of a deceased person, including the
state and each city and town therein, which has in its employ one or more individuals
during any calendar year after January 1, 1975. For the purposes of this section,
the term "employer� shall refer only to an employer with persons employed within the
state.
(4) "Health benefits plan� means any plan by which health benefits are paid by an insurer,
the state, or the United States.
(5) "Health maintenance organization� means an organized system of health care that accepts
the responsibility to provide, or otherwise assure the delivery of, an agreed upon
set of comprehensive health maintenance and treatment services, for a voluntarily
enrolled group of persons in a geographic area and is reimbursed through a pre-negotiated
and fixed periodic payment made by or on behalf of each person or family unit enrolled
in the plan.
(6) "Health services� means those medical, professional, and paraprofessional services
provided to a person to prevent disease, to maintain health, to detect disease and
disability in its early stages, to diagnose and treat illness, and to rehabilitate
a person to the person's fullest capacities.
(7) "Insurer� includes all persons, firms, or corporations offering and/or insuring health
services on a prepaid basis, including, but not limited to, policies of accident and
sickness insurance, as defined by chapter 18 of title 27, nonprofit hospital or medical service plans, as defined by chapters 19 and 20 of
title 27, or any other entity whose primary function is to provide diagnostic, therapeutic,
or preventive services to a defined population on the basis of a periodic premium.
It includes all persons, firms, or corporations providing health benefits coverage
for employees on a self-insurance basis without the intervention of other entities.
(8) "Maternity benefits� means benefits rendered for normal obstetrical care. It includes
benefits for the completion of obstetrics, prenatal care, care of the newborn infant,
labor, delivery, and puerperium care. The term includes benefits for normal deliveries
or for any complications of pregnancy that do not result in delivery of a viable fetus.
(9) "Physician� means any person duly licensed to practice surgery or medicine pursuant
to the provisions of chapters 29, 31.1, and 37 of title 5 (except dental hygienists),
and comparable laws of other countries.
(10) "Qualified program� means those health benefits plans that provide for the payment
of health services by insurers through plans that have been certified as qualified
by the director of the department of business regulation pursuant to this chapter.
(11) "State� means the state of Rhode Island.
(12) "United States� means the government of the United States of America or any of its
instrumentalities.