31 Pa. Code § 89.802

Current through Register Vol. 54, No. 44, November 2, 2024

Section 89.802 - Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

ACIP-The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, United States Department of Health and Human Services.

AWP-Average wholesale price.

Act-The Childhood Immunization Insurance Act (40 P. S. §§ 3501-3508).

Child-An individual covered under a health insurance policy who is either the insured and under 21 years of age, or the insured's spouse and under 21 years of age, or a dependent child pursuant to the definitions of the policy.

Child immunization-The immunization of a child, in accordance with § 89.806 (relating to coverage of child immunizations). The immunization will be reimbursed at the rate of the cost of the immunization up to 150% of the AWP of the immunizing agent.

Departments-The Department of Health and the Insurance Department.

Health insurance policy-Except for specified disease policies, a group health insurance policy, contract or plan, or an individual policy, contract or plan with dependent coverage for children, which provides medical coverage on an expense-incurred, service or prepaid basis. The term includes the following:

(i) A health insurance policy or contract issued by a nonprofit corporation subject to 40 Pa.C.S. Chapters 61, 63 and 65 (relating to hospital plan corporations; professional health services plan corporations; and fraternal benefit societies).

(ii) A health service plan operating under the Health Maintenance Organization Act (40 P. S. §§ 1551-1568).

(iii) A health insurance policy, contract or plan issued by or to an entity not exempt from Pennsylvania law by virtue of the Employee Retirement Income Security Act of 1974 (ERISA) (Pub. L. No. 93-406, 88 Stat. 829), including multiple employer welfare arrangements, as defined in section 3(40)(A) of that act (29 U.S.C.A. § 1002(40)(A)).

Immunization-The immunizing agent, as well as, its storage and its administration by a person authorized by law to administer an immunizing agent, and a procedure or material associated with the process of immunizing with the exception of a procedure or material employed due to a medical complication such as an adverse reaction to the immunizing agent.

Immunizing agent-An antigenic substance such as a vaccine or toxoid, or an antibody-containing preparation such as a globulin or antitoxin, when used to actively or passively immunize.

MMWR-The Morbidity and Mortality Weekly Report published by the Centers for Disease Control and Prevention, United States Department of Health and Human Services.

31 Pa. Code § 89.802