940 CMR, § 26.03
Advertisement shall have the same meaning as set forth in 940 CMR 6.00.
Ancillary Services shall include, but are not limited to, audiology, dental, vision, mental health, substance abuse, physical therapy, chiropractic and podiatry services.
Clear and Conspicuous shall have the same meaning as set forth in 940 CMR 6.00.
Discount Health Plan shall mean 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, ancillary or pharmacy services and the right to receive discounts on medical, ancillary or pharmacy services provided under the discount health plan from those providers. Discount Health Plan does not include:
(a) any program offered by or through a governmental or government-sponsored program, including Medicaid, Medicare or state-administered prescription pharmacy programs;
(b) any insured health plan product offered by a health carrier including a product that includes a discount program offered to enrollees when the discount program is incidental to the insurance product; or
(c) a patient access program.
Discount Health Plan Organization shall mean an entity that, in exchange for fees, dues, charges or other consideration, contracts with providers, provider networks or other discount health plan organizations to provide access for discount health plan members to providers to receive specified medical, ancillary or pharmacy services from those providers at a discount.
Health Carrier shall mean an insurer licensed or otherwise authorized to transact accident or health insurance under M.G.L. c. 175; a nonprofit hospital service corporation organized under M.G.L. c. 176A; a nonprofit medical service corporation organized under M.G.L. c. 176B; a dental service corporation organized under M.G.L. c. 176E; an optometric service corporation organized Under M.G.L. c. 176F; or a health maintenance organization organized under M.G.L. c. 176G.
Marketing Material shall mean any material used to promote, sell or distribute a discount health plan, including by a private label entity that places its name on and markets or distributes a discount health plan pursuant to a marketing agreement with a discount health plan organization.
Medical Services shall mean any maintenance care of, or preventive care for, the human body or care, service or treatment of an illness or dysfunction of, or injury to, the human body, including, not limited to, physician care, inpatient care, all surgical services, skilled nursing care, rehabilitative services, emergency services, ambulance services, laboratory services, diagnostic and imaging services and medical equipment and supplies. Medical Services does not include pharmacy services or ancillary services.
Member shall mean any individual who pays fees, dues, charges or other consideration for the right to receive the benefits of a discount health plan. Member does not include any individual who enrolls in a patient access program.
Patient Access Program shall mean a voluntary program sponsored by a pharmaceutical manufacturer, or a consortium of pharmaceutical manufacturers, that provides free or discounted health care products directly to low-income or uninsured individuals either through a discount card or direct shipment program.
Person shall have the same meaning as set forth in 940 CMR 3.00.
Pharmacy Services shall include pharmaceutical supplies and prescription drugs.
Prospective Member shall mean any individual who has been solicited, orally or through advertisements, marketing material or brochures, to pay fees, dues, charges or other consideration for the right to receive the benefits of a discount medical plan or discount prescription drug plan.
Provider shall mean any physician, pharmacist or other health care practitioner who is licensed, accredited or certified to perform specified medical, pharmaceutical or ancillary services within the scope of his or her license, accreditation, certification or other appropriate authority pursuant to the General Laws or any facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical, ancillary or pharmacy services to members.
Provider Network shall mean an entity that negotiates directly or indirectly with a discount health plan organization on behalf of more than one provider to provide members with access to medical, ancillary or pharmacy services.
940 CMR, § 26.03