44-4702. Terms, defined.

349 words·~2 min read·/ne/chapter-44/44-4702

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

For purposes of the Prepaid Limited Health Service Organization Act:

(1)Director shall mean the Director of Insurance;

(2)Enrollee shall mean an individual, including dependents, who is entitled to limited health services pursuant to a contract with an entity authorized to provide or arrange for such services under the act;

(3)Evidence of coverage shall mean any certificate, agreement, or contract issued pursuant to section 44-4709 setting forth the coverage to which an enrollee is entitled;

(4)Limited health services shall mean dental care services, vision care services, mental health services, substance abuse services, pharmaceutical services, podiatric care services, and such other services as may be determined by the director to be limited health services. Limited health services shall not include hospital, medical, surgical, or emergency services except as such services are provided incident to the limited health services set forth in this subdivision;

(5)Prepaid limited health service organization shall mean any corporation, partnership, limited liability company, or other entity which, in return for a prepayment, undertakes to provide or arrange for the provision of one or more limited health services to enrollees. Prepaid limited health service organization shall not include

(a)an entity otherwise authorized pursuant to the laws of this state either to provide any limited health service on a prepayment or other basis or to indemnify for any limited health service,

(b)an entity that meets the requirements of section 44-4707 , or

(c)a provider or entity when providing or arranging for the provision of limited health services pursuant to a contract with a prepaid limited health service organization or with an entity described in subdivision (5)(a) or

(b)of this section;

(6)Provider shall mean any physician, dentist, health facility, or other person or institution which is duly licensed or otherwise authorized to deliver or furnish limited health services; and

(7)Subscriber shall mean the person whose employment or other status, except for family dependency, is the basis for entitlement to limited health services pursuant to a contract with an entity authorized to provide or arrange for such services under the act.