Regulation .02 Definitions.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
Carrier.
(a)
“Carrier” means:
(i)
An insurer;
(ii)
A nonprofit health service plan;
(iii)
A health maintenance organization;
(iv)
A dental plan organization; and
(v)
Any other person or organization that provides health benefit plans subject to State regulation.
(b)
“Carrier” includes an entity that arranges a provider panel for a carrier.
(2)
“Provider” means a health care practitioner or a group of health care practitioners licensed or otherwise authorized by law to provide health care services.
(3)
Provider Panel.
(a)
“Provider panel” means those providers with which a carrier contracts to provide health care services to the carrier's enrollees under the carrier's health benefit plan.
(b)
“Provider panel” does not include an arrangement between a carrier and providers in which a provider may participate solely on the basis of the provider's contracting with the carrier to provide services at a discounted fee-for-service rate.