23-99-403. Definitions.

23-99-403. Definitions. As used in this subchapter: (1) “Acute condition” means a medical condition, illness, or disease having a short and relatively severe course; (2) “Commissioner” means the Insurance Commissioner; (3) “Covered person” means a person on whose behalf the healthcare insurer issuing or delivering the health benefit plan is obligated to pay benefits pursuant to the health benefit plan; (4)(A) “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this state, including indemnity and managed care plans and including self-insured governmental and church plans, but excluding plans providing healthcare services pursuant to Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., and the Public Employee Workers' Compensation Act, § 21-5-601 et seq. (B) “Health benefit plan” does not include an accident-only, specified disease, hospital indemnity, long-term care, disability income, or other limited-benefit health insurance policy; (5) “Healthcare insurer” or “insurer” means any insurance company, hospital and medical service corporation, or health maintenance organization issuing or delivering health benefit plans in this state and subject to the following laws: (A) The Arkansas Insurance Code; (B) Section 23-76-101 et seq., pertaining to health maintenance organizations; (C) Section 23-75-101 et seq., pertaining to hospital and medical service corporations; and (D) Any successor laws of the foregoing; (6) “Managed care 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 participating providers; (7)(A) “Orthotic device” means an external device that is: (i) Intended to restore physiological function or cosmesis to a patient; and (ii) Custom-designed, fabricated, assembled, fitted, or adjusted for the patient using the device prior to or concurrent with the delivery of the device to the patient. (B) “Orthotic device” does not include a cane, a crutch, a corset, a dental appliance, an elastic hose, an elastic support, a fabric support, a generic arch support, a low-temperature plastic splint, a soft cervical collar, a truss, or other similar device that: (i) Is carried in stock and sold without therapeutic modification by a corset shop, department store, drug store, surgical supply facility, or similar retail entity; and (ii) Has no significant impact on the neuromuscular, musculoskeletal, or neuromusculoskeletal functions of the body; (8) “Orthotic service” means the evaluation and treatment of a condition that requires the use of an orthotic device; (9) “Participating provider” means a provider who or that has agreed to provide healthcare services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly or indirectly, from the healthcare insurer; (10) “Person” or “entity” means and includes, individually and collectively, any individual, corporation, partnership, firm, trust, association, voluntary organization, or any other form of business enterprise or legal entity; (11) “Policyholder” means the employer, union, individual, or other person or entity that purchases, issues, or sponsors a health benefit plan; (12)(A) “Prosthetic device” means an external device that is: (i) Intended to replace an absent external body part for the purpose of restoring physiological function or cosmesis to a patient; and (ii) Custom-designed, fabricated, assembled, fitted, or adjusted for the patient using the device prior to or concurrent with being delivered to the patient. (B) “Prosthetic device” does not include an artificial eye, an artificial ear, a dental appliance, a cosmetic device such as artificial eyelashes or wigs, a device used exclusively for athletic purposes, an artificial facial device, or other device that does not have a significant impact on the neuromuscular, musculoskeletal, or neuromusculoskeletal functions of the body; (13) “Prosthetic service” means the evaluation and treatment of a condition that requires the use of a prosthetic device; (14) “Specialty” means a provider's particular area of specialty within his or her licensed scope of practice; and (15) “Type” of provider means the licensed scope of practice.