House Journal: Page 1268: Wednesday, April 14, 1999

15   the medical profession in the community.

16     2.  "Enrollee" means an individual who is enrolled
17   in a health care plan, including covered dependents.
18     3.  "Health care plan" means a plan under which a
19   person undertakes to provide, arrange for, pay for, or
20   reimburse any part of the cost of any health care
21   services.
22     4.  "Health care provider" means a person licensed
23   or certified under chapter 147, 148, 148A, 148C, 149,
24   150, 150A, 151, 152, 153, 154, 154B, or 155A to
25   provide in this state professional health care
26   services to an individual during that individual's
27   medical care, treatment, or confinement.
28     5.  "Health care treatment decision" means a
29   determination made when health care services are
30   actually provided under the health care plan and a
31   decision which affects the quality of the diagnosis,
32   care, or treatment provided to the plan's insureds or
33   enrollees.
34     6.  "Health insurance carrier" means an entity
35   subject to the insurance laws and regulations of this
36   state, or subject to the jurisdiction of the
37   commissioner of insurance, that contracts or offers to
38   contract, or that subcontracts or offers to
39   subcontract, to provide, deliver, arrange for, pay
40   for, or reimburse any of the costs of providing health
41   care services, including an insurance company offering
42   sickness and accident plans, a health maintenance
43   organization, a nonprofit health service corporation,
44   or any other entity providing a plan of health
45   insurance, health benefits, or health services.
46     7.  "Health maintenance organization" means a
47   health maintenance organization as defined in section
48   514B.1.
49     8.  "Insured" means an individual who is covered by
50   a health care plan provided by a health insurance
Page 2  
 1   carrier.
 2     9.  "Managed care entity" means an entity that
 3   provides a health care plan that selects and contracts
 4   with health care providers; manages and coordinates
 5   health care services delivery; monitors necessity,
 6   appropriateness, and quality of health care services
 7   delivered by health care providers; and performs
 8   utilization review and cost control.
 9     10.  "Ordinary care" means, in the case of a third-
10   party payor, that degree of care that a third-party of
11   ordinary prudence would provide under the same or
12   similar circumstances.  In the case of a person who is
13   an employee, agent, or representative of a third-party

© 1999 Cornell College and League of Women Voters of Iowa

Comments about this site or page? hjourn@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.

Last update: Thu Apr 15 13:40:03 CDT 1999
URL: /DOCS/GA/78GA/Session.1/HJournal/01200/01268.html
jhf