Public-domain · open source
OpenJurist

Ark. Code Ann. § 23-99-1301

Definitions

Acts 2019, No. 736, § 1.

As used in this subchapter:

(1) “Contracting entity” means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;

(2) “Enrollee” means a person who is entitled to receive healthcare services under the terms of a health benefit plan;

(3) “Health benefit plan” means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state.

(4) “Health benefit plan” does not include: A disability income plan;

(5) A credit insurance plan;

(6) Insurance coverage issued as a supplement to liability insurance;

(7) Medical payments under an automobile or homeowners insurance plan;

(8) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;

(9) A plan that provides only indemnity for hospital confinement;

(10) An accident-only plan;

(11) A specified disease plan;

(12) A long-term care insurance plan;

(13) A dental-only plan; or

(14) A vision-only plan;

(15) “Healthcare contract” means a contract entered into, materially amended, or renewed between a contracting entity and a healthcare provider for the delivery of healthcare services to enrollees;

(16) “Healthcare insurer” means an entity that is subject to state insurance regulation and provides health insurance in this state.

(17) “Healthcare insurer” includes: An insurance company;

(18) A health maintenance organization;

(19) A hospital and medical service corporation;

(20) A risk-based provider organization; and

(21) A sponsor of a nonfederal self-funded governmental plan;

(22) “Healthcare provider” means a person or entity that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services;

(23) “Healthcare services” means services or goods provided for the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury;

(24) “Out-of-network provider” means a healthcare provider that provides healthcare services to an enrollee but is not a participating provider;

(25) “Participating provider” means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity; and

(26) “Payor” means a contracting entity or healthcare insurer responsible for payment for healthcare services provided to an enrollee under the terms of a healthcare contract or a health benefit plan.

Current official text: Arkansas General Assembly. Digitized from the UniCourt Code Improvement Commission public-domain capture. Reproduced from public-domain Arkansas statutes; confirm against the official source for the current text. Not legal advice.