§ 58-17E-5 — Definitions.

South Dakota § 58-17E-5

• Jurisdiction: South Dakota
• Title 58: INSURANCE
• Ch. 58-17E: DISCOUNT MEDICAL PLANS

Text

Terms used in this chapter mean: (1) "Ancillary services," includes audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services; (2) "Facility," an institution providing medical or ancillary services or a health care setting. The term includes: (a) A hospital or other licensed inpatient center; (b) An ambulatory surgical or treatment center; (c) A skilled nursing center; (d) A residential treatment center; (e) A rehabilitation center; and (f) A diagnostic, laboratory or imaging center; (3) "Health care professional," a physician, pharmacist, or other health care practitioner who is licensed, accredited, or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification, or other appropriate authority consistent with state law; (4) "Marketer," a person or entity that markets, promotes, sells, or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization; (5) "Medical services," any maintenance care of, or preventive care for, the human body, or care, service, or treatment of an illness or dysfunction of, or injury to, the human body. The term includes physician care, inpatient care, hospital surgical services, emergency services, ambulance services, dental care services, vision care services, mental health services, substance abuse services, chiropractic services, podiatric services, laboratory services, medical equipment and supplies, pharmacy services or ancillary services; (6) "Medicare prescription drug plan," a plan that provides Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Prescription Drug, Improvement and Modernization Act of 2003; (7) "Member," any individual who pays fees, dues, charges, or other consideration for the right to receive the benefits of a discount medical plan. Member does not include any individual who enrolls in a patient access program; (8) "Patient access program," a voluntary program sponsored by a pharmaceutical manufacturer or a consortium of pharmaceutical manufacturers, that provide free or discounted health care products directly to low-income or uninsured individuals either through a discount card or direct shipment; (9) "Provider," any health care professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members; (10) "Provider network," an entity that negotiates directly or indirectly with a discount medical plan organization on behalf of more than one provider to provide medical or ancillary services to members.

Legislative History

SL 2006, ch 257, § 5.