376.1500. Definitions.
Definitions.
376.1500. As used sections 376.1500 to 376.1532, the following words orphrases mean:
(1) "Director", the director of the department of insurance, financialinstitutions and professional registration;
(2) "Discount card", a card or any other purchasing mechanism or device,which is not insurance, that purports to offer discounts or access todiscounts in health-related purchases from health care providers;
(3) "Discount medical plan", a business arrangement or contract in whicha person, in exchange for fees, dues, charges, or other consideration,provides access for plan members to providers of medical services and theright to receive medical services from those providers at a discount. Theterm does not include any product regulated as an insurance product, grouphealth service product or membership in a health maintenance organization inthis state or discounts provided by an insurer, group health service, orhealth maintenance organizations where those discounts are provided at no costto the insured or member and are offered due to coverage with a licensedinsurer, group health service, or health maintenance organization. The termdoes not include an arrangement where the discounts or prices are sold,rented, or otherwise provided to another licensed carrier, self-insured orself-funded employer sponsored plan, Taft-Hartley trust, or licensed thirdparty administrator;
(4) "Discount medical plan organization", a person or an entity thatoperates a discount medical plan;
(5) "Health care provider", any person or entity licensed by this stateto provide health care services including, but not limited to physicians,hospitals, home health agencies, pharmacies, and dentists;
(6) "Health care provider network", an entity which directly contractswith physicians and hospitals and has contractual rights to negotiate onbehalf of those health care providers with a discount medical planorganization to provide medical services to members of the discount medicalplan organization;
(7) "Marketer", a person or entity who markets, promotes, sells ordistributes a discount medical plan, including a private label entity thatplaces its name on and markets or distributes a discount medical plan but doesnot operate a discount medical plan;
(8) "Medical services", any care, service or treatment of illness ordysfunction of, or injury to, the human body including, but not limited to,physician care, inpatient care, hospital surgical services, emergencyservices, ambulance services, dental care services, vision care services,mental health services, substance abuse services, chiropractic services,podiatric care services, laboratory services, and medical equipment andsupplies. The term does not include pharmaceutical supplies or prescriptions;
(9) "Member", any person who pays fees, dues, charges, or otherconsideration for the right to receive the purported benefits of a discountmedical plan; and
(10) "Person", an individual, corporation, business trust, estate,trust, partnership, association, joint venture, limited liability company, orany other government or commercial entity.
(L. 2007 H.B. 818)Definitions.Effective 1-01-08
*This section was enacted by H.B. 818 and S.B. 66 during the First Regular Session of the 94th General Assembly, 2007. Due to possible conflict, both versions are printed here.
376.1500. As used in sections 376.1500 to 376.1532, the followingwords or phrases mean:
(1) "Director", the director of the department of insurance,financial institutions and professional registration;
(2) "Discount card", a card or any other purchasing mechanism ordevice, which is not insurance, that purports to offer discounts or accessto discounts in health-related purchases from health care providers;
(3) "Discount medical plan", a business arrangement or contract inwhich a person, in exchange for fees, dues, charges, or otherconsideration, provides access for plan members to providers of medicalservices and the right to receive medical services from those providers ata discount. The term does not include any product regulated as aninsurance product, group health service product or membership in a healthmaintenance organization in this state or discounts provided by an insurer,group health service, or health maintenance organizations where thosediscounts are provided at no cost to the insured or member and are offereddue to coverage with a licensed insurer, group health service, or healthmaintenance organization. The term does not include an arrangement wherethe discounts or prices are sold, rented or otherwise provided to anotherlicensed carrier or to a self-insured or self-funded employer sponsoredplan or Taft-Hartley trust;
(4) "Discount medical plan organization", means a person or an entitythat, in exchange for fees, dues, charges or other consideration, providesaccess for plan members to providers of medical services and the right toreceive medical services from those providers at a discount. It is theperson or organization that contracts with providers, provider networks orother discount medical plan organizations to offer access to medicalservices at a discount and determines the charge to plan members;
(5) "Health care provider", any person or entity licensed by thisstate to provide health care services including, but not limited tophysicians, hospitals, home health agencies, pharmacies, and dentists;
(6) "Health care provider network", an entity which directlycontracts with physicians and hospitals and has contractual rights tonegotiate on behalf of those health care providers with a discount medicalplan organization to provide medical services to members of the discountmedical plan organization;
(7) "Marketer", a person or entity who markets, promotes, sells ordistributes a discount medical plan, including a private label entity thatplaces its name on and markets or distributes a discount medical plan butdoes not operate a discount medical plan;
(8) "Medical services", any care, service or treatment of illness ordysfunction of, or injury to, the human body including, but not limited to,physician care, inpatient care, hospital surgical services, emergencyservices, ambulance services, dental care services, vision care services,mental health services, substance abuse services, chiropractic services,podiatric care services, laboratory services, and medical equipment andsupplies. The term does not include pharmaceutical supplies orprescriptions;
(9) "Member", any person who pays fees, dues, charges, or otherconsideration for the right to receive the purported benefits of a discountmedical plan; and
(10) "Person", an individual, corporation, business trust, estate,trust, partnership, association, joint venture, limited liability company,or any other government or commercial entity.
(L. 2007 S.B. 66)*This section was enacted by H.B. 818 and S.B. 66 during the First Regular Session of the 94th General Assembly, 2007. Due to possible conflict, both versions are printed here.