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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.
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