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:

“Child.” A person under 13 years of age, except as provided for in section 701(d).¹

“Children's medical assistance.” Medical assistance services to children as required under Title 14 of the Social Security Act (Public Law 74-271, 42 U.S.C. § 301 et seq.), including EPSDT services.

“Council.” The Children's Health Advisory Council established in section 701(i).

“Department.” The Department of Public Welfare of the Commonwealth.²

“EPSDT.” Early and periodic screening, diagnosis and treatment.

“Fund.” The Children's Health Fund for health care for indigent children established by section 1296 of the act of March 4, 1971 (P.L. 6, No. 2),³ known as the Tax Reform Code of 1971.

“Genetic status.” The presence of a physical condition in an individual which is a result of an inherited trait.

“Grantee.” An entity selected by the management team to receive a grant under Chapter 7.⁴ The term includes an entity, and its subsidiary, which is established under 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations); the act of May 17, 1921 (P.L. 682, No. 284),⁵ known as The Insurance Company Law of 1921; or the act of December 29, 1972 (P.L. 1701, No. 364),⁶ known as the Health Maintenance Organization Act.

“Group.” A group for which a health insurance policy is written in this Commonwealth.

“Health maintenance organization” or “HMO.” An entity organized and regulated under the act of December 29, 1972 (P.L. 1701, No. 364), known as the Health Maintenance Organization Act.

“Health service corporation.” A professional health service corporation as defined in 40 Pa.C.S. § 6302 (relating to definitions).

“Hospital.” An institution having an organized medical staff which is engaged primarily in providing to inpatients, by or under the supervision of physicians, diagnostic and therapeutic services for the care of injured, disabled, pregnant, diseased or sick or mentally ill persons. The term includes facilities for the diagnosis and treatment of disorders within the scope of specific medical specialties. The term does not include facilities caring exclusively for the mentally ill.

“Hospital plan corporation.” A hospital plan corporation as defined in 40 Pa.C.S. § 6101 (relating to definitions).

“Insurer.” Any insurance company, association, reciprocal, nonprofit hospital plan corporation, nonprofit professional health service plan, health maintenance organization, fraternal benefits society or a risk-bearing PPO or nonrisk-bearing PPO not governed and regulated under the Employee Retirement Income Security Act of 1974 (Public Law 93-406, 29 U.S.C. § 1001 et seq.).

“MAAC.” The Medical Assistance Advisory Committee.

“Managed care organization.” A health maintenance organization organized and regulated under the act of December 29, 1972 (P.L. 1701, No. 364), known as the Health Maintenance Organization Act, or a risk-assuming preferred provider organization or exclusive provider organization, organized and regulated under the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921.

“Management team.” The Children's Health Insurance Management Team established in section 701(f).

“MCH.” Maternal and Child Health.

“Medical assistance.” The State program of medical assistance established under the act of June 13, 1967 (P.L. 31, No. 21),⁷ known as the Public Welfare Code.

“Medicaid.” The Federal medical assistance program established under Title XIX of the Social Security Act (Public Law 74-271, 42 U.S.C. § 1396 et seq.).

“Mid-level health professional.” A physician assistant, certified registered nurse practitioner, nurse practitioner or a certified nurse midwife.

“Parent.” A natural parent, stepparent, adoptive parent, guardian or custodian of a child.

“PPO.” A preferred provider organization subject to the provisions of section 630 of act of May 17, 1921 (P.L. 682, No. 284),⁸ known as The Insurance Company Law of 1921.

“Preexisting condition.” A disease or physical condition for which medical advice or treatment has been received prior to the effective date of coverage.

“Secretary.” The Secretary of the Department of Health.

“Spenddown.” A qualifying procedure for medical assistance set forth in 55 Pa. Code Ch. 181 (relating to income provisions for categorically needy NMP-MA and MNO-MA).

“Subgroup.” An employer covered under a contract issued to a multiple employer trust or to an association.

“Terminate.” Includes cancellation, nonrenewal and rescission.

“Waiting period.” A period of time after the effective date of enrollment during which a health insurance plan excludes coverage for the diagnosis or treatment of one or more medical conditions.

“WIC.” The Federal Supplemental Food Program for Women, Infants and Children.