KRS 304.17A-170: Definitions for KRS 304.17A-170 and 304.17A-171.

As used in this section and KRS 304.17A-171, unless the context requires otherwise:

(1) "Health benefit plan" has the meaning provided in KRS 304.17A-005.

(2) "Primary chiropractic provider" means a chiropractor licensed pursuant to KRS

Chapter 312 who has been selected by a person covered by a health benefit plan to

provide chiropractic service and who agrees to provide within the statutory scope of

their respective practices these services in accordance with the terms, conditions,

reimbursement rates, and standards of quality as set forth within the specific health

benefit plan.

(3) "Participating chiropractic provider" means a primary chiropractic provider who has

contracted with a health insurer to provide chiropractic services within the proper

scope of practice to persons insured under the health benefit plan of the insurer.

(4) "Chiropractic benefits" means those services that are provided by a primary

chiropractic provider who is functioning within the statutory scope of practice.

(5) "Gatekeeper system" means a system of administration used by any health benefit

plan in which a primary care provider furnishes basic patient care and coordinates

diagnostic testing, indicated treatment, and specialty referral for persons covered by

the health benefit plan.

(6) "Gatekeeper" means a covered person's primary care provider in a gatekeeper

system.

(7) "Health care insurer" means any entity, including but not limited to insurance

companies, hospital and medical services corporations, health maintenance

organizations, preferred provider organizations, and physician hospital

organizations, that is authorized by the state of Kentucky to offer or provide health

benefit plans, policies, subscriber contracts, or any other contracts of similar nature

which indemnify or compensate health care providers for the provision of health

care services.

(8) "Covered persons" means any individual or family who is enrolled in a health

benefit plan or policy from a health care insurer and on whose behalf the health care

insurer is obligated to pay for or provide chiropractic services.

(9) "Covered service" means those health care services including chiropractic services

which the health care insurer is obligated to pay for or provide to covered persons

under the health benefit plan o r policy or pursuant to KRS 304.17 -305 or 304.18 -

095.