18 Del. Admin. Code § 1310-3.0

Current through Register Vol. 28, No. 5, November 1, 2024
Section 1310-3.0 - Definitions

The following words and terms, when used in this regulation, shall have the following meaning unless the context clearly indicates otherwise:

"Carrier" means any entity that provides health insurance in this State. For the purposes of this regulation, carrier includes a health insurance company, health service corporation, health maintenance organization and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. "Carrier" also includes any 3rd-party administrator or other entity that adjusts, administers or settles claims in connection with health benefit plans.

"Days" means calendar days.

"Institutional Provider" means a hospital, nursing home, or any other medical or health-related service facility caring for the sick or injured or providing care or other coverage which may be provided in a health insurance policy. An entity must be a Provider under this Regulation in order to be an Institutional Provider.

"Policyholder," "Insured," or "Subscriber" means a person covered under a health insurance policy or a representative (other than a provider) designated by such person and entitled to make claims on his behalf.

"Provider" means any entity or individual licensed, certified, or otherwise permitted by law pursuant to Titles 16 or 24 of the Delaware Code to provide health care services, irrespective of whether the entity or the individual is a participating provider pursuant to a written agreement with the carrier. When used alone, the term "provider" shall include individual providers and institutional providers.

18 Del. Admin. Code § 1310-3.0

7 DE Reg. 100 (7/1/03)
9 DE Reg. 242 (8/1/05)