Section 420-B:1 Definitions.
In this chapter:
I. ""Advertising'' means:
(a) Printed and published material and descriptive literature of an insurer used in newspapers, magazines, radio and television scripts, billboards, and similar displays;
(b) Descriptive literature and sales aids of all kinds issued by an insurer for presentation to members of the public, including, but not limited to, marketing, educational, or information letters; and
(c) Sales talks, presentations and material prepared by insurers for use by agents and brokers, and representations made by agents and brokers in accordance therewith.
II. ""Commissioner'' means the insurance commissioner.
II-a. ""Date of enrollment'' means the first day of coverage under the plan, or, if there is a waiting period, the first day of the waiting period, which is typically the first day of work.
III. ""Enrolled participant'' means a person who has entered into a contractual arrangement or on whose behalf a contractual arrangement has been entered into with a health maintenance organization to receive health care services.
IV. ""Evidence of coverage'' means any certificate, agreement, or contract issued to an enrolled participant setting out the coverage to which such participant is entitled including those issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) as amended.
V. ""Health care services'' means physician, hospitalization, laboratory, x-ray service and medical equipment and supplies, which may include but are not limited to: medical, surgical, and dental care; psychological, obstetrical, osteopathic, optometric, optic, podiatric, chiropractic, nursing, physical therapy services, and pharmaceutical services; health education; preventive medical, rehabilitative, and home health services; inpatient and outpatient hospital services, extended care, nursing home care, convalescent institutional care, laboratory and ambulance services, appliances, drugs, medicines, and supplies; and any other care, service, or treatment of disease, correction of defects, or the maintenance of the physical and mental well-being of enrolled participants.
VI. ""Health maintenance organization'' means a public or private organization, organized under the laws of this state or the laws of another state which:
(a) Provides or otherwise makes available to enrolled participants health care services;
(b) Is compensated for the provision of one or more health care services to an enrolled participant on a primarily predetermined periodic rate basis;
(c) Provides physicians' services directly through physicians who are either employees or partners of such an organization, or under arrangements with one or more physicians or groups of physicians.
VII. ""Provider'' means any physician, hospital or other institution, organization, or other person who furnishes health care services.
Source. 1977, 282:1. 1997, 282:1, eff. Jan. 1, 1998. 2007, 289:14, eff. Jan. 1, 2008.