RSA 415-I:3 · Definitions

415-I:3 Definitions. – In this chapter:

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I.

"Ancillary services" includes, but is not limited to, audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services.

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II.

"Commissioner" means the insurance commissioner.

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III.

"Discount medical plan" means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers. "Discount medical plan" does not include:

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(a)

Any discount arrangement that involves the transfer of insurance risk from a subscriber to another entity, or arrangement or contract for claim processing functions.

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(b)

A plan that does not charge a membership or other fee to the member to use the plan's discount medical card.

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(c)

A plan that provides a Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Prescription Drug Improvement and Modernization Act of 2003.

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(d)

A plan that provides direct primary care meeting the requirements of RSA 329:1-e.

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IV.

"Discount medical plan organization" means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount. "Discount medical plan organization" is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or ancillary services at a discount and determines the charge to discount medical plan members. "Discount medical plan organization" does not include a provider that offers discounts to its own patients without any cost or fee of any kind to the patient. "Discount medical plan organization" shall not include providers of direct primary care meeting the requirements of RSA 329:1-e.

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V.

"Health care professional" means a physician, pharmacist, or other health care practitioner who is licensed, accredited, or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification, or other appropriate authority and consistent with state law.

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VI.

"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 costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or medical or ancillary services.

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VII.

"Marketer" means a person or entity that markets, promotes, sells, or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization.

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VIII.

"Medical services" means any service, supply, or drug intended for the maintenance care of, or preventive care for, the human body or the care, or treatment of an illness or dysfunction of, or injury to, the human body. "Medical services" includes, but is not limited to, physician care, inpatient care, hospital surgical services, emergency services, ambulance services, laboratory services, pharmaceutical supplies, prescription drugs, and medical equipment and supplies. "Medical services" does not include ancillary services.

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IX.

"Member" means any individual who pays fees, dues, charges, or other consideration for the right to receive the benefits of a discount medical plan.

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X.

"Participating provider" means any health care professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members.

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XI.

"Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing.

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XII.

"Provider" means an institution or individual that offers medical or medically-related services in a health care setting.

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XIII.

"Third party administrator" means a third party administrator as defined by RSA 402-H. Source. 2008, 206:1, eff. Jan. 1, 2009. 2019, 330:2, 3, eff. Oct. 15, 2019.

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