40-4602. Same; definitions. - Kansas Statutes

40-4602

Chapter 40.--INSURANCE Article 46.--MANAGED CARE

      40-4602.   Same; definitions.As used in this act:

      (a)   "Emergency medical condition" means the sudden and, at the time,unexpected onset of a health condition that requires immediate medicalattention, where failure to provide medical attention would result in seriousimpairment to bodily functions or serious dysfunction of a bodily organ orpart, or would place the person's health in serious jeopardy.

      (b)   "Emergency services" means ambulance services and health care items andservices furnished orrequired to evaluate and treat an emergency medical condition, as directed orordered by a physician.

      (c)   "Health benefit plan" means any hospital or medical expense policy,health, hospital or medical service corporation contract, a plan provided by amunicipal group-funded pool, a policy or agreement entered into by a healthinsurer or a health maintenance organization contract offered by an employer orany certificate issued under any such policies, contracts or plans. "Healthbenefit plan" does not include policies or certificates covering only accident,credit, dental, disability income, long-term care, hospital indemnity, medicaresupplement, specified disease, vision care, coverage issued as a supplement toliability insurance, insurance arising out of a workers compensation or similarlaw, automobile medical-payment insurance, or insurance under which benefitsare payable with or without regard to fault and which is statutorily requiredto be contained in any liability insurance policy or equivalent self-insurance.

      (d)   "Health insurer" means any insurance company, nonprofit medical andhospital service corporation, municipal group-funded pool, fraternal benefitsociety, health maintenance organization, or any other entity which offers ahealth benefit plan subject to the Kansas Statutes Annotated.

      (e)   "Insured" means a person who is covered by a health benefit plan.

      (f)   "Participating provider" means a provider who, under a contract with thehealth insurer or with its contractor or subcontractor, has agreed to provideone or more health care services to insureds with an expectation ofreceiving payment, other than coinsurance, copayments or deductibles, directlyor indirectly from the health insurer.

      (g)   "Provider" means a physician, hospital or other person which islicensed, accredited or certified to perform specified health care services.

      (h)   "Provider network" means those participating providers who have enteredinto a contract or agreement with a health insurer to provide items or healthcare services to individuals covered by a health benefit plan offered by suchhealth insurer.

      (i)   "Physician" means a person licensed by the state board of healing artsto practice medicine and surgery.

      History:   L. 1997, ch. 190, § 17; July 1.