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KRS 304.38-030

Definitions for subtitle

Known as the Health Maintenance Organization Act

The act spans §§ 304–304 (53 sections).

Effective: July 15, 2010 History: Amended 2010 Ky

As used in this subtitle, unless the context otherwise requires:

(1) "Commissioner" means the commissioner of the Department of Insurance;

(2) "Enrollee" means a person who has been enrolled in a health maintenance organization;

(3) "Evidence of coverage" means any certificate, agreement, contract, or other document issued to an enrollee stating the health care services to which the enrollee is entitled. All coverages described in an evidence of coverage issued by a health maintenance organization are deemed to be "health benefit plans" to the extent defined in KRS 304.17A-005 unless exempted by the commissioner;

(4) "Health care services" means any services included in the furnishing to any individual of medical, optometric, or dental care, or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services and goods for the purpose of preventing, alleviating, curing, or healing human illness, physical disability, or injury;

(5) "Health maintenance organization" means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basis. A health maintenance organization is authorized to provide all health care services;

(6) "Person" includes but is not limited to any individual, partnership, association, trust, or corporation; and (7) "Provider" means a person or group of persons licensed to practice medicine, osteopathy, dentistry, podiatry, optometry, or another health profession in a state or licensed to act as a hospital or another health care facility.

Official source: Kentucky General Assembly. Reproduced from public-domain Kentucky statutes; confirm against the official source for the current text. Not legal advice.