33-2-2002. Definitions.
174 words·~1 min read·
/mt/title-33/chapter-2/part-20/33-2-2002·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
33-2-2002 . Definitions. As used in this part, the following definitions apply:
(1)"Audit" means a review of the records of a pharmacy by or on behalf of an entity that finances or reimburses the cost of health care services or pharmaceutical products.
(2)"Entity" includes:
(a)a pharmacy benefits manager;
(b)a health benefit plan;
(c)a third-party administrator; and
(d)a company, group, or agent that represents or is engaged by one of the entities described in this subsection (2).
(3)"Fraud" means an intentional act of deception, misrepresentation, or concealment in order to gain something of value.
(4)"Health benefit plan" means a policy or certificate that provides health care insurance or major medical expense insurance or that is offered as a substitute for hospital or medical expense insurance. The term does not include a policy or certificate that provides benefits solely for accident, dental, vision, income replacement, long-term care, a medicare supplement, a specified disease, or a short-term limited duration or that is offered and marketed as supplemental health insurance.