2006 Kentucky Revised Statutes - .170   Definitions for KRS 304.17A-170 and 304.17A-171.

304.17A-170 Definitions for KRS 304.17A-170 and 304.17A-171. As used in this section and KRS 304.17A-171, unless the context requires otherwise: (1)  "Health benefit plan" has the meaning provided in KRS 304.17A-005. (2)  "Primary chiropractic provider" means a chiropractor licensed pursuant to KRS Chapter 312 who has been selected by a person covered by a health benefit plan to provide chiropractic service and who agrees to provide within the statutory scope of their respective practices these services in accordance with the terms, conditions, reimbursement rates, and standards of quality as set forth within the specific health benefit plan. (3)  "Participating chiropractic provider" means a primary chiropractic provider who has contracted with a health insurer to provide chiropractic services within the proper scope of practice to persons insured under the health benefit plan of the insurer. (4)  "Chiropractic benefits" means those services that are provided by a primary chiropractic provider who is functioning within the statutory scope of practice. (5)  "Gatekeeper system" means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan. (6)  "Gatekeeper" means a covered person's primary care provider in a gatekeeper system. (7)  "Health care insurer" means any entity, including but not limited to insurance companies, hospital and medical services corporations, health maintenance organizations,  preferred  provider  organizations,  and  physician  hospital organizations, that is authorized by the state of Kentucky to offer or provide health benefit plans, policies, subscriber contracts, or any other contracts of similar nature which indemnify or compensate health care providers for the provision of health care services. (8)  "Covered persons" means any individual or family who is enrolled in a health benefit plan or policy from a health care insurer and on whose behalf the health care insurer is obligated to pay for or provide chiropractic services. (9)  "Covered service" means those health care services including chiropractic services which the health care insurer is obligated to pay for or provide to covered persons under the health benefit plan or policy or pursuant to KRS 304.17-305 or 304.18- 095. Effective: April 10, 1998 History: Amended 1998 Ky. Acts ch. 496, sec. 51, effective April 10, 1998. -- Created 1996 Ky. Acts ch. 187, sec. 1, effective July 15, 1996. Page 1 of 1