2013 Alaska Statutes
Title 21 - INSURANCE
Chapter 21.07 - PATIENT PROTECTIONS UNDER HEALTH CARE INSURANCE POLICIES
Sec. 21.07.250 Definitions.

In this chapter,

(1) "clinical peer" means a health care provider who is licensed to provide the same or similar medical care services and who is trained in the specialty or subspecialty applicable to the medical care services that are provided;

(2) "clinical trial" means treatment, research, study, or investigation over a period of time of an injury, illness, or medical condition;

(3) "emergency room services" means medical care services provided by a hospital or other emergency facility after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention would reasonably be expected by a prudent person who possesses an average knowledge of health and medicine to result in

(A) the placing of the person's health in serious jeopardy;

(B) a serious impairment to bodily functions; or

(C) a serious dysfunction of a bodily organ or part;

(4) "health care insurer" has the meaning given in AS 21.54.500 ;

(5) "health care provider" means a person licensed in this state or another state of the United States to provide medical care services;

(6) "health insurance" has the meaning given in AS 21.12.050 (a);

(7) "managed care" means a contract given to an individual, family, or group of individuals under which a member is entitled to receive a defined set of health care benefits in exchange for defined consideration and that requires the member to comply with utilization review guidelines; "managed care" does not include Medicaid coverage under 42 U.S.C. 1396 - 1396p (Social Security Act);

(8) "medical care" has the meaning given in AS 21.97.900 ;

(9) "medical emergency" means the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain that in the absence of immediate medical attention would reasonably be expected by a prudent person who possesses an average knowledge of health and medicine to result in

(A) the placing of the person's health in serious jeopardy;

(B) a serious impairment to bodily functions; or

(C) a serious dysfunction of any bodily organ or part;

(10) "participating health care provider" means a health care provider who has entered into an agreement with a health care insurer to provide services or supplies to a patient covered by a health care insurance policy;

(11) "primary care provider" means a health care provider who provides general medical care services and does not specialize in treating a single injury, illness, or condition or who provides obstetrical, gynecological, or pediatric medical care services;

(12) "provider" means a health care provider;

(13) "religious nonmedical provider" means a person who provides only religious nonmedical treatment or nursing care for an illness or injury;

(14) "utilization review" means a system of reviewing the medical necessity, appropriateness, or quality of medical care services and supplies provided under a health care insurance policy using specified guidelines, including preadmission certification, the application of practice guidelines, continued stay review, discharge planning, preauthorization of ambulatory procedures, and retrospective review.