KRS 304.38-030: Definitions for subtitle.

As used in this subtitle, unless the context otherwise requires:

(1) "Commissioner" means the commissioner of the Department of Insurance;

(2) "Enrollee" means a person who has been enrolled in a health maintenance

organization;

(3) "Evidence of coverage" means any certificate, agreement, contract, or other

document issued to an enrollee stating the health care services to which the enrollee

is entitled. All coverages described in an evidence of coverage issued by a health

maintenance organization are deeme d to be "health benefit plans" to the extent

defined in KRS 304.17A-005 unless exempted by the commissioner;

(4) "Health care services" means any services included in the furnishing to any

individual of medical, optometric, or dental care, or hospitalizati on or incident to

the furnishing of such care or hospitalization, as well as the furnishing to any person

of any and all other services and goods for the purpose of preventing, alleviating,

curing, or healing human illness, physical disability, or injury;

(5) "Health maintenance organization" means any person who undertakes to provide,

directly or through arrangements with others, health care services to individuals

enrolled with such an organization on a per capita or a predetermined, fixed

prepayment basis. A health maintenance organization is authorized to provide all

health care services;

(6) "Person" includes but is not limited to any individual, partnership, association, trust,

or corporation; and

(7) "Provider" means a person or group of persons licen sed to practice medicine,

osteopathy, dentistry, podiatry, optometry, or another health profession in a state or

licensed to act as a hospital or another health care facility.