As used in this subchapter:(1) 'Contracting entity' means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;(2) 'Enrollee' means a person who is entitled to receive healthcare services under the terms of a health benefit plan;(3)(A) 'Health benefit plan' means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state.(B) 'Health benefit plan' does not include:(i) A disability income plan;(ii) A credit insurance plan;(iii) Insurance coverage issued as a supplement to liability insurance;(iv) Medical payments under an automobile or homeowners insurance plan;(v) A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;(vi) A plan that provides only indemnity for hospital confinement;(vii) An accident-only plan;(viii) A specified disease plan;(ix) A long-term care insurance plan; or(x) A vision-only plan;(4) t seq.;(vi) A plan that provides only indemnity for hospital confinement;(vii) An accident-only plan;(viii) A specified disease plan;(ix) A long-term care insurance plan; or(x) A vision-only plan;(4) 'Healthcare contract' means a contract entered into, materially amended, or renewed between a contracting entity and a healthcare provider for the delivery of healthcare services to enrollees;(5)(A) 'Healthcare insurer' means an entity that is subject to state insurance regulation and provides health insurance in this state.(B) 'Healthcare insurer' includes:(i) An insurance company;(ii) A health maintenance organization;(iii) A hospital and medical service corporation;(iv) A risk-based provider organization; and(v) A sponsor of a nonfederal self-funded governmental plan;(6) 'Healthcare provider' means a person or entity that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services;(7) 'Healthcare services' means services or goods provided for the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury;(8) 'Out-of-network provider' means a healthcare r the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury;(8) 'Out-of-network provider' means a healthcare provider that provides healthcare services to an enrollee but is not a participating provider;(9) 'Participating provider' means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity; and(10) 'Payor' means a contracting entity or healthcare insurer responsible for payment for healthcare services provided to an enrollee under the terms of a healthcare contract or a health benefit plan.Amended by Act 2023, No. 831,§ 1, eff. 1/1/2024.Added by Act 2019, No. 736,§ 1, eff. 7/24/2019.
Arkansas Legal Code