Section Ins 2701.03 - Definitions(a) "Commissioner" means the insurance commissioner.(b) "Covered benefits" means those health care services and other medical services, including dental benefits, to which a covered person is entitled under the terms of a health benefit plan.(c) "Covered person" means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.(d) "Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of covered benefits with respect to any "health coverage" as defined in RSA 420-G:2, IX and any network-based coverage for dental services.(e) "Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the covered costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.(f) "Network" means the group of participating providers contracted under a network plan.(g) "Network plan" means a health benefit plan that either requires a covered person to use or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with, or employed by the health carrier.(h) "Participating provider" means a person or entity who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, co-payments, or deductibles, directly or indirectly from the health carrier.(i) "Primary care provider" means a physician licensed by the New Hampshire board of medicine or a board of medicine of another appropriate jurisdiction who has successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association in family practice, internal medicine, or pediatrics, or an advanced registered nurse practitioner licensed by the New Hampshire board of nursing in the advanced practice categories of family practice, internal medicine, or pediatrics, or a doctor of naturopathic medicine authorized and licensed to practice naturopathic medicine under RSA 328-E.(j) "Retail pharmacy" means any licensed pharmacy that is not a mail order pharmacy and is open to dispense prescription drugs to the walk-in public without being required to receive medical services from a provider or institution affiliated with that pharmacy.(k) "Urgent services" means health care services that are provided to treat a medical or behavioral health condition or symptomatic illness of a covered person that, if not treated within 48 hours, presents a risk of serious harm.N.H. Admin. Code § Ins 2701.03
#7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.01 )
Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12565, Effective 8/1/2018, Expires 8/1/2028.