33-22-1703. Definitions. As used in this part, the following definitions apply:
     (1) "Emergency services" means services provided after suffering an accidental bodily injury or the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that without immediate medical attention the subscriber or insured could reasonably expect that:
     (a) the subscriber's or insured's health would be in serious jeopardy;
     (b) the subscriber's or insured's bodily functions would be seriously impaired; or
     (c) a bodily organ or part would be seriously damaged.
     (2) "Health benefit plan" means the health insurance policy or subscriber arrangement between the insured or subscriber and the health care insurer that defines the covered services and benefit levels available.
     (3) "Health care insurer" means:
     (a) an insurer that provides disability insurance as defined in 33-1-207;
     (b) a health service corporation as defined in 33-30-101;
     (c) a health maintenance organization as defined in 33-31-102;
     (d) a fraternal benefit society as described in 33-7-105; or
     (e) any other entity regulated by the commissioner that provides health coverage.
     (4) "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization or services provided under Title 33, chapter 22, part 7.
     (5) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy or subscriber contract issued or administered by an insurer.
     (6) "Preferred provider" means a provider or group of providers who have contracted to provide specified health care services.
     (7) "Preferred provider agreement" means a contract between or on behalf of a health care insurer and a preferred provider.
     (8) "Provider" means an individual or entity licensed or legally authorized to provide health care services or services covered within Title 33, chapter 22, part 7.
     (9) "Subscriber" means a certificate holder or other person on whose behalf the health care insurer is providing or paying for health care coverage.

     History: En. Sec. 3, Ch. 638, L. 1987; amd. Sec. 67, Ch. 713, L. 1989; amd. Sec. 40, Ch. 586, L. 1991; amd. Sec. 32, Ch. 451, L. 1993.