§ 6902. Definitions
Oklahoma Statutes AnnotatedTitle 36. Insurance
36 Okl.St.Ann. § 6902
§ 6902. Definitions
As used in the Health Maintenance Organization Act of 2003:
provided, however, such term does not include dental services or long- term rehabilitation treatment;
2. “Capitated basis” means fixed per member per month payment or percentage of premium payment wherein the provider assumes the full risk for the cost of contracted services without regard to the type, value or frequency of services provided. For purposes of this definition, “capitated basis” includes the cost associated with operating staff model facilities;
13. “Health maintenance organization producer” means a person who solicits, negotiates, effects, procures, delivers, renews or continues a policy or contract for HMO membership, or who takes or transmits a membership fee or premium for such a policy or contract, other than for the person, or a person who advertises or otherwise holds himself or herself out to the public as a health maintenance organization producer;
20. “Participating provider” means a provider as defined in paragraph 22 of this section who, under an express or implied contract with the health maintenance organization, its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment or deductible, directly or indirectly from the health maintenance organization;
26. “Uncovered expenditures” means the costs to the health maintenance organization for health care services that are the obligation of the health maintenance organization, for which an enrollee may also be liable in the event of the health maintenance organization's insolvency and for which no alternative arrangements have been made that are acceptable to the Insurance Commissioner.
Credits
Laws 2003, c. 197, § 2, eff. Nov. 1, 2003.
36 Okl. St. Ann. § 6902, OK ST T. 36 § 6902
Current with emergency effective legislation through Chapter 257 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
End of Document |