2023 Rhode Island General Laws › Title 42 - State Affairs and Government › Chapter 42-62 - Catastrophic Health Insurance Plan Act › Section 42-62-4. - Definitions.

§ 42-62-4. Definitions.
For the purposes of this chapter:
(1)
“Benefit” or “health benefit” means a health service financed for a person by a third party such as an insurer or the state.
(2)
“Employee” means any person who has entered into the employment of or works under contract of service or apprenticeship with any employer. It shall not include a person who has been employed for less than thirty (30) days by his or her employer, nor shall it include a person who works less than an average of thirty (30) hours per week. For the purposes of this chapter, the term “employee” shall mean a person employed by an employer as defined in subdivision (1). Except as otherwise provided in this chapter, the terms “employee” and “employer” are to be defined according to the rules and regulations of the department of labor and training.
(3)
“Employer” means any person, partnership, association, trust, estate, corporation, whether foreign or domestic, or the legal representative, trustee in bankruptcy, receiver or trustee, thereof, or the legal representative of a deceased person, including the state and each city and town therein, which has in its employ one or more individuals during any calendar year after January 1, 1975. For the purposes of this section, the term “employer” shall refer only to an employer with persons employed within the state.
(4)
“Health benefits plan” means any plan by which health benefits are paid by an insurer, the state, or the United States.
(5)
“Health maintenance organization” means an organized system of health care which accepts the responsibility to provide, or otherwise assure the delivery of, an agreed upon set of comprehensive health maintenance and treatment services, for a voluntarily enrolled group of persons in a geographic area and is reimbursed through a pre-negotiated and fixed periodic payment made by or on behalf of each person or family unit enrolled in the plan.
(6)
“Health services” means those medical, professional, and paraprofessional services provided to a person to prevent disease, to maintain health, to detect disease and disability in its early stages, to diagnose and treat illness, and to rehabilitate a person to his or her fullest capacities.
(7)
“Insurer” includes all persons, firms, or corporations offering and/or insuring health services on a prepaid basis, including, but not limited to, policies of accident and sickness insurance, as defined by chapter 18 of title 27, nonprofit hospital or medical service plans, as defined by chapters 19 and 20 of title 27, or any other entity whose primary function is to provide diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium. It includes all persons, firms, or corporations providing health benefits coverage for employees on a self-insurance basis without the intervention of other entities.
(8)
“Maternity benefits” means benefits rendered for normal obstetrical care. It includes benefits for the completion of obstetrics, prenatal care, care of the newborn infant, labor, delivery, and puerperium care. The term includes benefits for normal deliveries or for any complications of pregnancy which do not result in delivery of a viable fetus.
(9)
“Physician” means any person duly licensed to practice surgery or medicine pursuant to the provisions of chapters 29, 31.1, and 37 of title 5, (except dental hygienists), and comparable laws of other countries.
(10)
“Qualified program” means those health benefits plans which provide for the payment of health services by insurers through plans which have been certified as qualified by the director of the department of business regulation pursuant to this chapter.
(11)
“State” means the state of Rhode Island.
(12)
“United States” means the government of the United States of America or any of its instrumentalities.
History of Section.
P.L. 1974, ch. 50, § 1; P.L. 1979, ch. 289, § 1; P.L. 1980, ch. 256, § 1; P.L. 1985, ch. 181, art. 21, § 1; P.L. 1988, ch. 84, § 30; P.L. 1990, ch. 65, art. 25, § 2.