35 Pa. Stat. § 5704.102

Current through Pa Acts 2024-53, 2024-56 through 2024-92

Section 5704.102 - Definitions

The following words and phrases when used in this act shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Enrollee." Any policyholder, subscriber, covered person or other individual who is entitled to receive health care services under a health insurance policy.

"Health insurance carrier." An entity that offers or issues a health insurance policy and is subject to any of the following:

(1) The act of May 17, 1921 ( P.L. 682, No.284), known as The Insurance Company Law of 1921, including section 630 and Article XXIV of the act.

(2) The act of December 29, 1972 ( P.L. 1701, No.364), known as the Health Maintenance Organization Act.

(3)40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).

"Health insurance policy." A policy, contract, certificate or agreement offered, issued or renewed by a health insurance carrier to provide coverage for health care services. The term does not include the following types of policies:

(1) Accident only.

(2) Limited benefit.

(3) Credit.

(4) Vision.

(5) Dental.

(6) Specified disease.

(7) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement.

(8) Long-term care or disability income.

(9) Workers' compensation.

(10) Automobile medical payment.

(11) Fixed indemnity.

(12) Hospital indemnity.

(13) Medicare supplement.

"Stage four, advanced metastatic cancer." Cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes or other areas or parts of the body.

35 P.S. § 5704.102

Added by P.L. TBD 2020 No. 6, § 2, eff. 4/12/2020.