Sec. 21.86.900. Definitions.

410 words·~2 min read·/ak/title-21/chapter-86/21-86-900

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

In this chapter,

(1)“affiliation period” means a period of time under a contract with a health maintenance organization

(A)that must expire before coverage becomes effective;

(B)during which the health maintenance organization is not required to provide health care services or benefits; and

(C)for which no premium is charged to the participant or beneficiary for coverage during the period;

(2)“agent” means a person who is appointed by a health maintenance organization and who engages in solicitation of membership in the organization; “agent” does not include a person enrolling health maintenance organization members on behalf of an employer, a union, or other organization to whom a master subscriber contract has been issued, or an employee, who is not an independent contractor, of the health maintenance organization;

(3)“basic health care services” means emergency care, inpatient hospital and physician care, and outpatient medical services, but does not include mental health services or services for alcohol or drug abuse;

(4)“beneficiary” has the meaning given in AS 21.54.500 ;

(5)“enrollee” means an individual who is enrolled in a health maintenance organization;

(6)“enrollment date” has the meaning given in AS 21.54.500 ;

(7)“evidence of coverage” means a certificate, agreement, or contract issued to an enrollee, setting out the coverage to which the enrollee is entitled;

(8)“group market” has the meaning given in AS 21.54.500 ;

(9)“health care services” means services for medical or dental care, or hospitalization, or services incident to the furnishing of that care or hospitalization, and includes services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability;

(10)“health maintenance organization” means a person that undertakes to provide or arrange for basic health care services to enrollees on a prepaid basis;

(11)“health status factor” has the meaning given in AS 21.54.500 ;

(12)“participant” has the meaning given in AS 21.54.500 ;

(13)“person” has the meaning given in AS 01.10.060 and includes a joint venture;

(14)“preexisting condition exclusion” has the meaning given in AS 21.54.500 ;

(15)“provider” means a physician, hospital, or other person licensed or otherwise authorized in this state to furnish health care services;

(16)“uncovered expenditures” means the costs of health care services that are covered by a health maintenance organization, but for which an enrollee would also be liable if the organization became insolvent;

(17)“waiting period” has the meaning given in AS 21.54.500 .