18 Del. Admin. Code § 1313-2.0

Current through Register Vol. 28, No. 5, November 1, 2024
Section 1313-2.0 - Definitions

"Carrier" or "insurance carrier" means any entity that provides health insurance in this State. Carrier includes an insurance company, health service corporation, managed care organization and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. Carrier also includes any third-party administrator or other entity that adjusts, administers or settles claims in connection with health insurance.

"Department" means the Delaware Insurance Department.

"Health care provider" or "provider" shall have the same meaning as defined at 18 Del.C. § 333 (a)(1).

"Health care services" means any services or supplies included in the furnishing to any individual of medical care, or hospitalization or incidental to the furnishing of such care or hospitalization, as well as the furnishing to any individual of any and all other services for the purpose of preventing, alleviating, curing or healing human illness, injury, disability or disease.

"Health insurance" means a plan or policy issued by a carrier for the payment for, provision of, or reimbursement for health care services.

"Petition filing" means either each patient or each procedure code, determined by the basis of the filing.

18 Del. Admin. Code § 1313-2.0

19 DE Reg. 924 (4/1/2016) (Final)