23-99-1301. Definitions.

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; (x) A dental-only plan; or (xi) 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.