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MAINE STATUTES AND CODES
24-A §2671. Definitions
Title 24-A: MAINE INSURANCE CODE
Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT HEADING: PL 1999, C. 609, §3 (RPR)
§2671. Definitions
As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings. [1985, c. 704, §4 (NEW).]
1. "Administrator" means any person, other than a carrier, that administers a preferred provider arrangement. An administrator does not include a health maintenance organization licensed pursuant to chapter 56 or a nonprofit health care plan regulated by the superintendent pursuant to Title 24. An employer exempt from the applicability of this chapter under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not considered an administrator.
[ 1999, c. 609, §5 (AMD) .]
1-A. "Capitation" has the same meaning as defined in section 4331, subsection 2.
[ 1999, c. 609, §5 (NEW) .]
2.
[ 1999, c. 609, §5 (RP) .]
2-A. "Carrier" means an insurance company licensed in accordance with this Title, a fraternal benefit society authorized pursuant to chapter 55 or a nonprofit hospital or medical service organization licensed pursuant to Title 24. An employer exempted from the applicability of this chapter under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not considered a carrier.
[ 1999, c. 609, §5 (NEW) .]
2-B. "Enrollee" means an individual entitled to reimbursement for expenses of health care services under a health plan.
[ 1999, c. 609, §5 (NEW) .]
3. "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's legal authorization.
[ 1985, c. 704, §4 (NEW) .]
3-A. "Health plan" means a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan.
[ 1999, c. 609, §5 (NEW) .]
4.
[ 1999, c. 609, §5 (RP) .]
5.
[ 1999, c. 609, §5 (RP) .]
6. "Preferred provider" means a provider who enters into a preferred provider arrangement with an administrator or carrier.
[ 1999, c. 609, §5 (AMD) .]
7. "Preferred provider arrangement" means a contract, agreement or arrangement between a carrier or administrator and a provider in which the provider agrees to provide services to a health plan enrollee whose plan benefits include incentives for the enrollee to use the services of that provider.
[ 1999, c. 609, §5 (AMD) .]
8. "Provider" means an individual or entity duly licensed or otherwise legally authorized to provide health care services, including, but not limited to, the treatment of physical health and mental health and provision for medical supplies and pharmaceutical supplies.
[ 1999, c. 609, §5 (AMD) .]
9. "Superintendent" means the Superintendent of Insurance.
[ 1999, c. 609, §5 (AMD) .]
SECTION HISTORY
1985, c. 704, §4 (NEW). 1995, c. 332, §P1 (AMD). 1999, c. 609, §5 (AMD).