§ 304-38-030

304.38 -030 Definitions for subtitle. As used in this subtitle, unless the context otherwise requires: (1) 'Commissioner' means the commissioner of the Department of Insurance; (2) 'Enrollee' means a person who has been enrolled in a health maintenance organization; (3) 'Evidence of coverage' means any certificate, agreement, contract, or other document issued to an enrollee stating the health care services to which the enrollee is entitled. All coverages described in an evidence of coverage issued by a health maintenance organization are deeme d to be 'health benefit plans' to the extent defined in KRS 304.17A -005 unless exempted by the commissioner; (4) 'Health care services' means any services included in the furnishing to any individual of medical, optometric, or dental care, or hospitalizati on or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services and goods for the purpose of preventing, alleviating, curing, or healing human illness, physical disability, or injury; (5) 'Health maintenance organization' means any person who undertakes to provide, directly or through arrangements with others, health

uring, or healing human illness, physical disability, or injury; (5) 'Health maintenance organization' means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basi s. A health maintenance organization is authorized to provide all health care services; (6) 'Person' includes but is not limited to any individual, partnership, association, trust, or corporation; and (7) 'Provider' means a person or group of persons licen sed to practice medicine, osteopathy, dentistry, podiatry, optometry, or another health profession in a state or licensed to act as a hospital or another health care facility. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1498, effec tive July 15, 2010. -- Amended 2002 Ky. Acts ch. 105, sec. 22, effective July 15, 2002. -- Amended 2000 Ky. Acts ch. 427, sec. 1, effective July 14, 2000. -- Created 1974 Ky. Acts ch. 357, subtit. 38, sec. 3, effective June 21, 1974.