Arkansas Code of 1987 (2023) › Title 23 - PUBLIC UTILITIES AND REGULATED INDUSTRIES (§§ 23-1-101 — 23-119-105) › Subtitle 3 - INSURANCE (§§ 23-60-101 — 23-103-417) › Chapter 99 - HEALTH CARE PROVIDERS (§§ 23-99-201 — 23-99-1802) › Subchapter 13 - ASSIGNMENT OF BENEFITS (§§ 23-99-1301 — 23-99-1305) › Section 23-99-1301 - Definitions

As used in this subchapter:
(1)
"Contracting entity" means a healthcare insurer or any subcontractor, affiliate, or other entity that contracts directly or indirectly with a healthcare provider for the delivery of healthcare services to enrollees;
(2)
"Enrollee" means a person who is entitled to receive healthcare services under the terms of a health benefit plan;
(3)
(A)
"Health benefit plan" means a plan, policy, contract, certificate, agreement, or other evidence of coverage for healthcare services offered or issued by a healthcare insurer in this state.
(B)
"Health benefit plan" does not include:
(i)
A disability income plan;
(ii)
A credit insurance plan;
(iii)
Insurance coverage issued as a supplement to liability insurance;
(iv)
Medical payments under an automobile or homeowners insurance plan;
(v)
A health benefit plan provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, §
11-9-101
et seq., or the Public Employee Workers' Compensation Act, §
21-5-601
et seq.;
(vi)
A plan that provides only indemnity for hospital confinement;
(vii)
An accident-only plan;
(viii)
A specified disease plan;
(ix)
A long-term care insurance plan; or
(x)
A vision-only plan;
(4)
"Healthcare contract" means a contract entered into, materially amended, or renewed between a contracting entity and a healthcare provider for the delivery of healthcare services to enrollees;
(5)
(A)
"Healthcare insurer" means an entity that is subject to state insurance regulation and provides health insurance in this state.
(B)
"Healthcare insurer" includes:
(i)
An insurance company;
(ii)
A health maintenance organization;
(iii)
A hospital and medical service corporation;
(iv)
A risk-based provider organization; and
(v)
A sponsor of a nonfederal self-funded governmental plan;
(6)
"Healthcare provider" means a person or entity that is licensed, certified, or otherwise authorized by the laws of this state to provide healthcare services;
(7)
"Healthcare services" means services or goods provided for the purpose of preventing, diagnosing, treating, alleviating, relieving, curing, or healing human illness, disease, condition, disability, or injury;
(8)
"Out-of-network provider" means a healthcare provider that provides healthcare services to an enrollee but is not a participating provider;
(9)
"Participating provider" means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment either directly from the contracting entity or from a healthcare insurer affiliated with the contracting entity; and
(10)
"Payor" means a contracting entity or healthcare insurer responsible for payment for healthcare services provided to an enrollee under the terms of a healthcare contract or a health benefit plan.
Amended by Act 2023, No. 831,§ 1, eff. 1/1/2024.
Added by Act 2019, No. 736,§ 1, eff. 7/24/2019.