Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 4 > Part III - Health and Accident Coverage

• Acquittal:
  1. Judgement that a criminal defendant has not been proved guilty beyond a reasonable doubt.
  2. A verdict of "not guilty."
   
• Actuarial certification: means a written statement by a member of the American Academy of Actuaries that a health insurance issuer is in compliance with the provisions of this Subpart, based upon the actuary's examination, including a review of the appropriate records and of the actuarial assumptions and methods utilized by the health insurance issuer in establishing rates for applicable health benefit plans. See Louisiana Revised Statutes 22:1091
• Administrator: means a third party other than the warrantor who is designated by the warrantor to be responsible for the administration of vehicle protection product warranties. See Louisiana Revised Statutes 32:1272
• Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Ambulatory surgical center: means an establishment in this state as defined in and licensed under the provisions of Louisiana Revised Statutes 22:1202
• Amortization: Paying off a loan by regular installments.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Appraisal: A determination of property value.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Articles: means the original articles of incorporation and all amendments thereto including those contained in merger agreements or, if restated, the latest restatement thereof except in those instances in which the context refers expressly to the original articles of incorporation only. See Louisiana Revised Statutes 6:201
• Assets: means all of a state bank's property and rights of every kind. See Louisiana Revised Statutes 6:201
• Authority: shall mean the political subdivision and body politic and corporate created, organized and existing pursuant to the provisions of this Chapter, or if the Authority shall be abolished, the board, body, commission, department or officer succeeding to the principal functions thereof or to whom the powers given by this chapter may be given by law. See Louisiana Revised Statutes 33:4545.3
• Authorized prescriber: means a person licensed, registered, or otherwise authorized by the appropriate licensing board to prescribe prescription drugs in the course of professional practice. See Louisiana Revised Statutes 22:1060.1
• Auto hulk: means any material which is or may have been a motor vehicle, with or without all component parts, which is not self-propelled nor capable of carrying persons or property upon a public highway and which material is in such condition that its highest or primary value is its sale or transfer as parts or scrap metal. See Louisiana Revised Statutes 32:702
• Auto title company: means any person, firm, association, or corporation which is engaged primarily in the transfer and recordation of sales, leases, or mortgages of vehicles including but not limited to mobile homes, trailers, and motor vehicles. See Louisiana Revised Statutes 32:702
• Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
• Base health care facility: means a facility or institution providing health care services, including but not limited to a hospital or other licensed inpatient center, ambulatory surgical or treatment center, skilled nursing facility, inpatient hospice facility, residential treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting that has entered into a contract or agreement with a facility-based physician. See Louisiana Revised Statutes 22:1019.1
• Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Benefits plan: means the coverages offered by the plan to eligible persons as defined by Louisiana Revised Statutes 22:1202
• Board: means the State Board of Elementary and Secondary Education. See Louisiana Revised Statutes 17:3822
• Board: means the Board of Supervisors of Community and Technical Colleges. See Louisiana Revised Statutes 17:3394.2
• Board: means the board of directors of the plan. See Louisiana Revised Statutes 22:1202
• booting: means the act of placing on a parked motor vehicle a mechanical device that is designed to be attached to the wheel or tire or other part of such vehicle so as to prohibit its usual manner of movement. See Louisiana Revised Statutes 32:1741
• Capital: means the sum of capital stock, surplus, and undivided profits or, as to mutual state banks, as defined by Louisiana Revised Statutes 6:201
• Caucus: From the Algonquian Indian language, a caucus meant "to meet together." An informal organization of members of the legislature that exists to discuss issues of mutual concern and possibly to perform legislative research and policy planning for its members. There are regional, political or ideological, ethnic, and economic-based caucuses.
• Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
• Chief judge: The judge who has primary responsibility for the administration of a court but also decides cases; chief judges are determined by seniority.
• Civil forfeiture: The loss of ownership of property used to conduct illegal activity.
• Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
• Commission: means the Louisiana Motor Vehicle Commission. See Louisiana Revised Statutes 32:1272
• Commissioner: shall mean the director of public safety as provided for in Louisiana Revised Statutes 32:702
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1019.1
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1132
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1202
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1242
• Commissioner: shall mean the commissioner of insurance. See Louisiana Revised Statutes 22:1260.2
• Committee: means the Teacher Incentive Pay Models Program Advisory Committee. See Louisiana Revised Statutes 17:3822
• Committee membership: Legislators are assigned to specific committees by their party. Seniority, regional balance, and political philosophy are the most prominent factors in the committee assignment process.
• Community college: means any postsecondary institution which offers an associate academic degree as well as vocational-technical and other educational programs, but which is not approved to offer a baccalaureate degree. See Louisiana Revised Statutes 17:3202
• Conservator: means the commissioner or his designee. See Louisiana Revised Statutes 6:381
• Contracted health care provider: means a health care provider that has entered into a contract or agreement directly with a health insurance issuer or through a network of providers for the provision of covered health care services. See Louisiana Revised Statutes 22:1242
• Contracting entity: means any person or entity, including a third-party administrator and a dental carrier, that enters into a direct contract with a provider for the delivery of dental services in the ordinary course of business. See Louisiana Revised Statutes 22:1171
• Corporation: means the nonprofit corporation which may be utilized to accomplish the purposes of this Part. See Louisiana Revised Statutes 17:3394.2
• cost of a project: shall mean , but shall not be limited to, the cost of acquisition, construction, reconstruction, improvement, enlargement, betterment or extension of any project, including the cost of studies, plans, specifications, surveys and estimates of costs and revenues relating thereto, the cost of labor and materials; the cost of land, land rights, rights-of-way and easements, water rights, fees, permits, approvals, licenses, certificates, franchises, and the preparation of applications for securing the same; administrative, legal, engineering and inspection expenses; financing fees, expenses and costs; working capital; costs of fuel and fuel supply resources and related facilities; interest on bonds during the period of construction and for such reasonable period thereafter as may be determined by the governing body; establishment of reserves; and all other expenditures of the Authority incidental, necessary or convenient to the acquisition, construction, reconstruction, improvement, enlargement, betterment or extension of any project and the placing of the same in operation. See Louisiana Revised Statutes 33:4545.3
• Covered health care services: means health care services that are either covered and payable under the terms of health insurance coverage or required by law to be covered. See Louisiana Revised Statutes 22:1019.1
• Covered health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease that are either covered and payable under the terms of the health insurance coverage. See Louisiana Revised Statutes 22:1242
• Covered person: means a policyholder, subscriber, enrollee, insured, or other individual participating in a health benefit plan. See Louisiana Revised Statutes 22:1019.1
• criminal street gang: means any ongoing organization, association, or group of three or more persons, whether formal or informal, which has as one of its primary activities the commission of one or more of the criminal acts enumerated in Paragraphs (1) through (13) of Subsection B of this Section or which has a common name or common identifying sign or symbol, whose members individually or collectively engage in or have engaged in a pattern of criminal gang activity. See Louisiana Revised Statutes 15:1404
• Dealer: shall mean any person engaged in the business of buying, selling or exchanging motor vehicles which are subject to license under Chapter 4 of the Subtitle II of Title 47 of the Louisiana Revised Statutes of 1950. See Louisiana Revised Statutes 32:702
• Dental benefit plan: means a benefit plan which pays or provides dental expense benefits for covered dental services and is delivered or issued for delivery by or through a dental carrier on a stand-alone basis. See Louisiana Revised Statutes 22:1171
• Dental carrier: means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services. See Louisiana Revised Statutes 22:1171
• Dental services: means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1171
• Dentist: means any person lawfully licensed by the Louisiana State Board of Dentistry to practice dentistry in this state. See Louisiana Revised Statutes 22:1171
• Department: means the Department of Education. See Louisiana Revised Statutes 17:3602
• Department: means the state Department of Education. See Louisiana Revised Statutes 17:3822
• Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1020.1
• Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1202
• Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1242
• Dependent: A person dependent for support upon another.
• Dependent: means a resident spouse or resident unmarried child under the age of twenty-one years, a child who is a student under the age of twenty-four years and who is financially dependent upon the parent, or a child of any age who is disabled and dependent upon the parent. See Louisiana Revised Statutes 22:1202
• Discount medical plan: shall mean a business arrangement or contract in which a person, in exchange for fees, dues, charges or other valuable consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. See Louisiana Revised Statutes 22:1260.2
• Discount medical plan card: shall mean a card or any other purchasing mechanism or device, which is not insurance, that purports to offer discounts or access to discounts in health-related purchases from health care providers. See Louisiana Revised Statutes 22:1260.2
• Discount medical plan organization: shall mean any person or organization that operates a discount medical plan and contracts with providers, provider networks or other discount medical plan organizations to offer access to medical services at a discount and determines the charge to discount medical plan members. See Louisiana Revised Statutes 22:1260.2
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Division of administration: means the division of administration created within the office of the governor by Title 39 of the Louisiana Revised Statutes of 1950. See Louisiana Revised Statutes 17:3394.2
• Donor: The person who makes a gift.
• drug: means any of the following:

  (a)  A substance for which federal or state law requires a prescription before the substance may be legally dispensed to the public. See Louisiana Revised Statutes 22:1060.1

• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. ^{Source: OCC}
• Emergency medical condition: means a medical condition manifesting itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy. See Louisiana Revised Statutes 22:1019.1
• Emergency services: means health care items and services furnished or required to evaluate and treat an emergency medical condition. See Louisiana Revised Statutes 22:1019.1
• Enrolled bill: The final copy of a bill or joint resolution which has passed both chambers in identical form. It is printed on parchment paper, signed by appropriate officials, and submitted to the President/Governor for signature.
• Enrollee: means a qualified individual or qualified employee enrolled in a qualified health plan. See Louisiana Revised Statutes 22:1260.32
• Enterprise: means any individual, sole proprietorship, partnership, corporation or other legal entity, or any unchartered association, or group of individuals associated in fact and includes unlawful as well as lawful enterprises and governmental as well as other entities. See Louisiana Revised Statutes 15:1352
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Entity: shall mean a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity. See Louisiana Revised Statutes 22:1260.2
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Essential community providers: means providers that serve predominantly low-income, medically underserved individuals, including those providers defined in Section 340B(a)(4) of the Public Health Service Act and providers described in Section 1927(c)(1)(D)(i)(IV) of the Social Security Act as set forth by Section 221 of Public Law 111-8. See Louisiana Revised Statutes 22:1019.1
• Ex officio: Literally, by virtue of one's office.
• Excessive: means the rate charged for the health insurance coverage causes the premium or premiums charged for the health insurance coverage to be unreasonably high in relation to the benefits provided under the particular product. See Louisiana Revised Statutes 22:1091
• exchange: means a governmental agency or nonprofit entity that meets the applicable standards of the Patient Protection and Affordable Care Act and makes qualified health plans available to qualified individuals and qualified employers. See Louisiana Revised Statutes 22:1260.32
• Executive director: means the executive director of the Louisiana Motor Vehicle Commission. See Louisiana Revised Statutes 32:1272
• Executive session: A portion of the Senate's daily session in which it considers executive business.
• Executor: A male person named in a will to carry out the decedent
• Expenditure: means the gift or payment of money or any thing of value for the purchase of food, drink, or refreshment for a local government official or for the spouse or minor child of a local government official for the purpose of lobbying or any gift or payment permitted by Louisiana Revised Statutes 33:9662
• Facility-based physician: means a physician licensed to practice medicine who is required by the base health care facility to provide services in a base health care facility, including an anesthesiologist, hospitalist, intensivist, neonatologist, pathologist, radiologist, emergency room physician, or other on-call physician, who is required by the base health care facility to provide covered health care services related to any medical condition. See Louisiana Revised Statutes 22:1019.1
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• FDIC: means the Federal Deposit Insurance Corporation, and includes any successor to the corporation or other agency or instrumentality of the United States which may undertake to discharge the purposes of the corporation. See Louisiana Revised Statutes 6:381
• Federal Deposit Insurance Corporation: A government corporation that insures the deposits of all national and state banks that are members of the Federal Reserve System. ^{Source: OCC}
• Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. ^{Source: OCC}
• Federal review threshold: means any rate increase that results in a ten percent or greater rate increase, or such other threshold as required by federal law or regulation or any rate that, when combined with all rate increases and decreases during the previous twelve-month period, would result in an aggregate ten percent or greater rate increase. See Louisiana Revised Statutes 22:1091
• Federally defined eligible individual: means an individual as defined by Louisiana Revised Statutes 22:1202
• Fiduciary: A trustee, executor, or administrator.
• Fiduciary: means any person, firm, partnership, association, or state bank, including a usufructuary, who or which occupies a position of peculiar confidence toward any person, firm, association, partnership, trust, or estate. See Louisiana Revised Statutes 6:201
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Forgery: The fraudulent signing or alteration of another's name to an instrument such as a deed, mortgage, or check. The intent of the forgery is to deceive or defraud. ^{Source: OCC}
• formulary: means a list of prescription drugs which meets any of the following criteria:

  (a)  For which a health benefit plan provides coverage. See Louisiana Revised Statutes 22:1060.1

• Fraud: Intentional deception resulting in injury to another.
• front footage: as used in this Chapter shall mean the footage of each lot or parcel of real estate abutting the right of way or street along which the distribution line is constructed. See Louisiana Revised Statutes 33:4160.5
• front footage: shall mean the footage of each lot or parcel of real estate abutting the right of way or street, along which the drainage line is constructed. See Louisiana Revised Statutes 33:4160.25
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Governing body: shall mean the board or body in which the general legislative powers of the Authority are vested pursuant hereto. See Louisiana Revised Statutes 33:4545.3
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Grace period: is a period that applies to recipients of advance payments of the premium tax credit allowed for certain individuals to purchase health insurance coverage on the exchange. See Louisiana Revised Statutes 22:1260.32
• Grantor: The person who establishes a trust and places property into it.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health and accident insurance: means hospital and medical expense incurred policies, nonprofit service plan corporation contracts, and coverages provided by health maintenance organizations, individual practices, associations, the Office of Group Benefits, and other similar entities and self-insurers. See Louisiana Revised Statutes 22:1202
• Health benefit plan: means a policy, contract, certificate, or subscriber agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Louisiana Revised Statutes 22:1019.1
• Health care facility: means an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings. See Louisiana Revised Statutes 22:1019.1
• Health care facility: means a facility or institution providing health care services including but not limited to a hospital or other licensed inpatient center, ambulatory surgical or treatment center, skilled nursing facility, inpatient hospice facility, residential treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting. See Louisiana Revised Statutes 22:1242
• Health care professional: means a physician or other health care practitioner licensed, certified, or registered to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:1019.1
• Health care professional: means a physician or other health care practitioner licensed, certified, or registered to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:1242
• Health care provider: means a person licensed by this state to provide health care or professional services under the provisions of Title 37 of the Louisiana Revised Statutes of 1950 or any professional corporation, as a health care provider, authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950 or such a person licensed by the appropriate laws of another state. See Louisiana Revised Statutes 22:1202
• Health care provider: shall mean any person licensed, certified, or registered in this state to provide health care services, including but not limited to physicians, hospitals, home health agencies, chiropractors, pharmacies and dentists. See Louisiana Revised Statutes 22:1260.2
• Health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1019.1
• Health care services: means services, items, supplies, or prescription drugs for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1060.1
• Health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1242
• Health coverage plan: means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident including a group insurance plan or self-insurance plan and the office of group benefits. See Louisiana Revised Statutes 22:1060.12
• Health insurance coverage: means benefits consisting of medical care provided or arranged for directly, through insurance or reimbursement, or otherwise, and includes health care services paid for under any health benefit plan. See Louisiana Revised Statutes 22:1019.1
• health insurance coverage: means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer. See Louisiana Revised Statutes 22:1091
• Health insurance coverage: means benefits consisting of medical care provided or arranged for directly, through insurance or reimbursement, or otherwise, and includes health care services paid for under any plan, policy, or certificate of insurance. See Louisiana Revised Statutes 22:1242
• Health insurance issuer: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits. See Louisiana Revised Statutes 22:1019.1
• Health insurance issuer: means an entity subject to the Louisiana Insurance Code and applicable regulations, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits. See Louisiana Revised Statutes 22:1060.12
• Health insurance issuer: means any entity that offers health insurance coverage through a policy, certificate of insurance, or subscriber agreement subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1091
• Health insurance issuer: means any entity that offers health insurance coverage through a policy or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1242
• Health insurance plan: means any hospital or medical insurance policy or certificate, qualified higher deductible health plan, health maintenance organization subscriber contract, contract providing benefits for dental care whether such contract is pursuant to a medical insurance policy or certificate, stand-alone dental plan, health maintenance provider contract, or managed healthcare plan. See Louisiana Revised Statutes 22:1171
• Health insurer: means any entity or person that issues health insurance plans as described in this Section. See Louisiana Revised Statutes 22:1171
• Health maintenance organization: means an organization as defined in Louisiana Revised Statutes 22:1202
• Healthcare facility: means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings. See Louisiana Revised Statutes 22:1020.1
• Healthcare professional: means a physician or other healthcare practitioner licensed, certified, or registered to perform specified healthcare services consistent with state law. See Louisiana Revised Statutes 22:1020.1
• Healthcare services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1020.1
• Hospital: means any facility as defined in Louisiana Revised Statutes 22:1202
• Hydrocarbon gas: means a combustible organic gas containing only one carbon and hydrogen. See Louisiana Revised Statutes 32:1601
• Inadequate: means rates for a particular product are clearly insufficient to sustain projected losses and expenses, or the use of such rates. See Louisiana Revised Statutes 22:1091
• Incidental costs: means expenses specified in the warranty incurred by the warranty holder related to the failure of the vehicle protection product to perform as provided in the warranty. See Louisiana Revised Statutes 32:1272
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• Index rate: means the average rate resulting from the estimated combined claims experience for all Essential Health Benefits, pursuant to Louisiana Revised Statutes 22:1091
• Indictment: The formal charge issued by a grand jury stating that there is enough evidence that the defendant committed the crime to justify having a trial; it is used primarily for felonies.
• Individual: shall mean a natural person. See Louisiana Revised Statutes 22:1260.2
• Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See Louisiana Revised Statutes 22:1091
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Insolvency: means that the assets of a state bank are insufficient to satisfy its obligations to its creditors and depositors. See Louisiana Revised Statutes 6:201
• Insurance arrangement: means any plan, program, contract, or any other arrangement under which one or more natural or juridical persons provide to their employees or participants, whether directly or indirectly, health care services or benefits other than through an insurer. See Louisiana Revised Statutes 22:1202
• insured: means an individual who is enrolled or insured by a health insurance issuer under a health benefit plan. See Louisiana Revised Statutes 22:1060.1
• Insured: includes any policyholder, including a dependent, enrollee, subscriber, or member, who is covered through any policy or subscriber agreement offered by a health insurance issuer. See Louisiana Revised Statutes 22:1091
• Insured: means any natural person domiciled in this state, other than a member of the plan, who is eligible to receive benefits from any insurer or insurance arrangement as defined in this Section. See Louisiana Revised Statutes 22:1202
• insured: means a person, including a spouse or dependent, who is enrolled in or insured by a health insurance issuer for health insurance coverage. See Louisiana Revised Statutes 22:1242
• Insurer: means any insurance company or other entity authorized to transact and transacting health and accident insurance business in this state. See Louisiana Revised Statutes 22:1202
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• issuer: means any entity that offers a health benefit plan through a policy, contract, or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1060.1
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• large employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one employees on business days during the preceding calendar year and who employs at least two employees on the first day of the plan year. See Louisiana Revised Statutes 22:1091
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legislative session: That part of a chamber's daily session in which it considers legislative business (bills, resolutions, and actions related thereto).
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Local government action: means any act by a local government agency or official to effectuate the public powers, functions, and duties of a local government official or a local government agency, including but not limited to any act in the nature of policymaking, rulemaking, adjudication, licensing, regulation, or enforcement; relative to contracts, requests for proposals, development of specifications, or engaging another person to perform a governmental function; to adopt, repeal, increase, or decrease any fee imposed on the affairs, actions, or persons regulated by a local government agency; or to affect the passage, defeat, or implementation of any legislation. See Louisiana Revised Statutes 33:9662
• Manufacturer: means any person regularly engaged in the business of manufacturing or assembling new motor vehicles, either within or without this state. See Louisiana Revised Statutes 32:702
• Marketer: shall mean any person who markets, promotes, sells or distributes a discount medical plan, including but not limited to a private label entity that places its name on and markets or distributes a discount medical plan. See Louisiana Revised Statutes 22:1260.2
• Material and substantial disruption: means when a person, with the intent and knowledge of doing so, significantly hinders expressive activity, prevents the communication of the message, or prevents the transaction of the business of a lawful meeting, gathering, or procession by either of the following:

              (a) Engaging in fighting, violence, or similar unlawful behavior. See Louisiana Revised Statutes 17:3399.31

• Medicaid: means coverage provided under the state plan for Title XIX of the Social Security Act, 42 USC 1396 et seq. See Louisiana Revised Statutes 22:1202
• Medical care: means amounts paid for as defined in Louisiana Revised Statutes 22:1202
• Medical loss ratio: means the ratio of expected incurred benefits to expected earned premium over the time period of coverage, subject to the requirements of federal law, regulation, or rule. See Louisiana Revised Statutes 22:1091
• Medical services: shall mean any care, service, or treatment of illness or dysfunction of, or injury to, the human body, including but not limited to physician care, inpatient care, outpatient care, hospital surgical services, emergency services, ambulance services, chiropractic services, dental services, audiology services, vision care services, mental health services, substance abuse services, podiatric care services, laboratory services and medical equipment and supplies. See Louisiana Revised Statutes 22:1260.2
• Medicare: means coverage under both Parts A and B of Title XVIII of the Social Security Act, Louisiana Revised Statutes 22:1202
• Member: means a person covered by the plan. See Louisiana Revised Statutes 22:1202
• Member: shall mean any individual who pays valuable consideration to receive the purported benefits of a discount medical plan. See Louisiana Revised Statutes 22:1260.2
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Motor vehicle: means every vehicle which is self-propelled, excluding a motorized bicycle. See Louisiana Revised Statutes 32:1601
• municipality: as used in this Chapter , means municipalities and parishes to which the Chapter is applicable. See Louisiana Revised Statutes 33:9611
• National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. ^{Source: OCC}
• National Credit Union Administration: The federal regulatory agency that charters and supervises federal credit unions. (NCUA also administers the National Credit Union Share Insurance Fund, which insures the deposits of federal credit unions.) ^{Source: OCC}
• Nationally recognized clinical practice guidelines: means evidence-based clinical guidelines developed by independent organizations or medical professional societies, including but not limited to the National Comprehensive Cancer Network, the American Society of Clinical Oncology, and the American Society of Hematology, utilizing a transparent methodology and reporting structure and having policies against conflicts of interest. See Louisiana Revised Statutes 22:1060.12
• network: means an entity, including a health insurance issuer, that, through contracts or agreements with health care providers, provides or arranges for access by groups of covered persons to health care services by health care providers who are not otherwise or individually contracted directly with a health insurance issuer. See Louisiana Revised Statutes 22:1019.1
• network: means an entity other than a health insurance issuer that, through contracts with health care providers, provides or arranges for access by groups of enrollees or insureds to health care services by health care providers who are not otherwise or individually contracted directly with a health insurance issuer. See Louisiana Revised Statutes 22:1242
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• official: means an elected official, an appointed official, or an employee in a local government agency. See Louisiana Revised Statutes 33:9662
• Oversight: Committee review of the activities of a Federal agency or program.
• Participating municipality: shall mean any municipality in the state of Louisiana that, on the effective date of this Act, is engaged in the generation, transmission, or distribution of electricity and which, pursuant to the procedures provided herein, becomes represented by a director appointed by said municipality to the board of directors of the Authority. See Louisiana Revised Statutes 33:4545.3
• Particular product: means a basic insurance policy form, certificate, or subscriber agreement delineating the terms, provisions, and conditions of a specific type of coverage or benefit under a particular type of contract with a discrete set of rating and pricing methodologies that a health insurance issuer offers in the state. See Louisiana Revised Statutes 22:1091
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• pattern of criminal gang activity: means the commission or attempted commission of two or more of the following offenses, provided that the offenses occurred within a three-year period, and the offenses are committed on separate occasions or by two or more persons:

  (1)  Aggravated battery or second degree battery as defined in Louisiana Revised Statutes 15:1404

• Pattern of racketeering activity: means engaging in at least two incidents of racketeering activity that have the same or similar intents, results, principals, victims, or methods of commission or otherwise are interrelated by distinguishing characteristics and are not isolated incidents, provided at least one of such incidents occurs after August 21, 1992, and that the last of such incidents occurs within five years after a prior incident of racketeering activity. See Louisiana Revised Statutes 15:1352
• Person: shall mean any individual, firm, corporation, partnership or association. See Louisiana Revised Statutes 32:702
• Person: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination thereof. See Louisiana Revised Statutes 22:1019.1
• Person: shall mean an individual or an entity. See Louisiana Revised Statutes 22:1260.2
• Personal property: All property that is not real property.
• Persons: means any individual, partnership, corporation, association, firm, or other business entity. See Louisiana Revised Statutes 32:1741
• Physician: means a person licensed by the Louisiana State Board of Medical Examiners. See Louisiana Revised Statutes 22:1060.1
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Plan: means an uncompleted professional improvement program. See Louisiana Revised Statutes 17:3602
• plan: means an entity which provides benefits through or by a health insurance issuer consisting of health care services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract; however, "health benefit plan" shall not include benefits due under Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950 or limited benefit and supplemental health insurance policies, benefits provided under a separate policy, certificate, or contract of insurance for accidents, disability income, limited scope dental or vision benefits,  benefits for long-term care, nursing home care, home health care, or specific diseases or illnesses, or any other limited benefit policy or contract as defined in Louisiana Revised Statutes 22:1060.1
• Plan: means the Louisiana Health Plan as created in Louisiana Revised Statutes 22:1202
• Plan of operation: means the plan of operation of the plan, including articles, bylaws, and operating rules, adopted by the board pursuant to Louisiana Revised Statutes 22:1202
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Positron emission tomography: means an imaging test that uses radioactive substances to visualize and measure metabolic processes in the body to help reveal how tissue and organs are functioning. See Louisiana Revised Statutes 22:1060.12
• Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. ^{Source: OCC}
• Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
• President pro tempore: A constitutionally recognized officer of the Senate who presides over the chamber in the absence of the Vice President. The President Pro Tempore (or, "president for a time") is elected by the Senate and is, by custom, the Senator of the majority party with the longest record of continuous service.
• Prime network: means a network that requires contracted health care providers to accept the amount payable for covered health care services as payment in full for such services. See Louisiana Revised Statutes 22:1242
• Prior authorization: means a determination by a health insurance issuer or person contracting with a health insurance issuer that healthcare services ordered by the provider to an individual or an enrollee are medically necessary and appropriate. See Louisiana Revised Statutes 22:1060.12
• Private property: means any privately owned parking facility at any location or any parking lot or street which is privately owned and is located near or contiguous to premises having one or more stores or business establishments which is used for the parking of motor vehicles or for vehicular travel by the owner or customers of such establishments and those having express or implied permission of the owner. See Louisiana Revised Statutes 32:1741
• Probable cause: A reasonable ground for belief that the offender violated a specific law.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Program: means a completed five-year professional improvement program, or refers to the subject of this Chapter. See Louisiana Revised Statutes 17:3602
• Program: means the Teacher Incentive Pay Models Program established in this Chapter. See Louisiana Revised Statutes 17:3822
• Program: means the Louisiana Guaranteed Benefits Pool. See Louisiana Revised Statutes 22:1132
• Project: shall mean any system or facilities proposed, existing or under construction within the state for the generation, transmission, transformation or supply of electric power and energy by any means whatsoever, or for the development, production, manufacture, procurement, handling, transportation, storage, fabrication, enrichment, processing or reprocessing of fuel of any kind or any facility or rights with respect to the supply of water, any interest therein, securities issued in connection with the financing thereof and any right to output, capacity or services thereof, but does not include facilities for the distribution of electric energy for retail sale. See Louisiana Revised Statutes 33:4545.3
• Project: means the acquisition, purchase, construction, renovation, improvement, or expansion of a public facility, to be financed as authorized and provided in this Part and Louisiana Revised Statutes 17:3394.2
• provider: means a health care professional or a health care facility. See Louisiana Revised Statutes 22:1019.1
• Provider: means an individual or entity which, acting within the scope of licensure or certification, provides dental services or supplies defined by the health insurance plan or dental benefit plan. See Louisiana Revised Statutes 22:1171
• provider: means a health care professional or a health care facility or the agent or assignee of such professional or facility. See Louisiana Revised Statutes 22:1242
• Provider network contract: means a contract between a contracting entity and a provider that specifies the rights and responsibilities of the contracting entity and provides for the delivery and payment of dental services to an enrollee. See Louisiana Revised Statutes 22:1171
• Public defender: Represent defendants who can't afford an attorney in criminal matters.
• Public facilities: means buildings, equipment, and other permanent property or immovable property of the colleges within the Louisiana Community and Technical College System, as specifically identified in Louisiana Revised Statutes 17:3394.2
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Public program: means any public assistance program which provides funding for health care services rendered by a health care provider that is directly subsidized by the federal government. See Louisiana Revised Statutes 22:1202
• Public school: means any public elementary, middle, junior high, or high school in this state. See Louisiana Revised Statutes 17:3602
• Qualified health plan: means a health insurance plan that has in effect a certification that the qualified health plan meets applicable state or federal standards required for participation in a health insurance exchange. See Louisiana Revised Statutes 22:1260.32
• Qualified health plan issuer: means a health insurance issuer that offers a qualified health plan in accordance with a certification from an exchange. See Louisiana Revised Statutes 22:1260.32
• racketeering activity: means committing, attempting to commit, conspiring to commit, or soliciting, coercing, or intimidating another person to commit any crime that is punishable under the following provisions of Title 14 of the Louisiana Revised Statutes of 1950, the Uniform Controlled Dangerous Substances Law, or the Louisiana Securities Law:

              (1) Louisiana Revised Statutes 15:1352

• Rate: means the rate initially filed or filed as a result of determination of rates by a health insurance issuer for a particular product. See Louisiana Revised Statutes 22:1091
• rate increase: includes a premium volume-weighted average increase for all insureds for the aggregate rate changes during the twelve-month period preceding the proposed rate increase effective date. See Louisiana Revised Statutes 22:1091
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Receiver: means the person liquidating a state bank pursuant to Part II of this Subchapter. See Louisiana Revised Statutes 6:381
• Receivership court: means the district court for the parish in which the state bank is domiciled. See Louisiana Revised Statutes 6:381
• Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. ^{Source: FDIC}
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• revenue bonds: shall mean bonds, notes and other evidences of indebtedness of the Authority issued by the authority pursuant to the provisions of this chapter. See Louisiana Revised Statutes 33:4545.3
• Self-insurer: means a natural or juridical person which provides health care services or reimbursement for all or any part of the costs of health care for its employees or participants in this state other than through an insurer. See Louisiana Revised Statutes 22:1202
• Service of process: The service of writs or summonses to the appropriate party.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Shares: means the units into which the stockholders' rights to participate in the control of the state bank, in its profits, or in the distribution of corporate assets are divided. See Louisiana Revised Statutes 6:201
• small employer: means any person, firm, corporation, partnership, trust, or association actively engaged in business which has employed an average of at least one but not more than fifty employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See Louisiana Revised Statutes 22:1091
• Small employer: means any person, firm, corporation, partnership, or association actively engaged in business which, on at least fifty percent of its working days during the preceding year, employed not less than one nor more than twenty-five eligible employees. See Louisiana Revised Statutes 22:1202
• square footage: shall mean the area of land measured in square feet to be improved or benefitted by the improvements to be constructed. See Louisiana Revised Statutes 33:4160.25
• State: shall mean the State of Louisiana, and

  8. See Louisiana Revised Statutes 33:4545.3

• Stockholder: means the holder of record of one or more shares. See Louisiana Revised Statutes 6:201
• Subpoena duces tecum: A command to a witness to produce documents.
• Summons: Another word for subpoena used by the criminal justice system.
• Superintendent: means the state superintendent of education. See Louisiana Revised Statutes 17:3822
• Teacher: means any public school classroom teacher, librarian, school counselor, secondary vocational instructor, principal, assistant principal, or other personnel for whom a valid Louisiana teaching certificate is required for employment; any teacher in an institution which offers thirteenth and fourteenth grade instruction; any speech therapist who possesses a valid Louisiana ancillary certificate issued by the State Board of Elementary and Secondary Education; and any instructor seeking to continue in the program who has been transferred from the Department of Public Safety and Corrections to vocational-technical schools under the State Board of Elementary and Secondary Education. See Louisiana Revised Statutes 17:3602
• Teaching certificate: means a certificate issued by the department to school personnel pursuant to the requirements fixed by the department or by law. See Louisiana Revised Statutes 17:3602
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Third party: means a person or entity that enters into a contract with a contracting entity or with another third party to gain access to the dental services or contractual discounts of a provider network contract. See Louisiana Revised Statutes 22:1171
• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• Total voting power: means the entirety of the voting power. See Louisiana Revised Statutes 6:201
• Trustee: A person or institution holding and administering property in trust.
• Unfairly discriminatory: means rates that result in premium differences between insureds within similar risk categories that do not reasonably correspond to differences in expected costs. See Louisiana Revised Statutes 22:1091
• Unit: shall mean any governmental unit, any investor-owned electric power company and any electric cooperative association or corporation and, in addition, any state, any department, institution, commission, public instrumentality or political subdivision of any state, or of the United States presently owning a system or facilities for the generation, transmission or distribution of electric power and energy for public and private uses. See Louisiana Revised Statutes 33:4545.3
• Unjustified: means a rate for which a health insurance issuer has provided data or documentation to the department in connection with rates for a particular product that is incomplete, inadequate, or otherwise does not provide a basis upon which the reasonableness of the rate may be determined or is otherwise inadequate insofar as the rate charged is clearly insufficient to sustain projected losses and expenses. See Louisiana Revised Statutes 22:1091
• Unreasonable: means any rate that contains a provision or provisions that are any of the following:

              (a) Excessive. See Louisiana Revised Statutes 22:1091

• Utilization review: means a set of formal techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of, healthcare services, procedures, or settings. See Louisiana Revised Statutes 22:1060.12
• Vehicle: shall include those devices sometimes referred to as mobile homes as defined in Louisiana Revised Statutes 32:702
• Vehicle protection product: means a vehicle protection device, system, or service that is:

  (i)  Installed on or applied to a vehicle. See Louisiana Revised Statutes 32:1272

• Victim advocate: work with prosecutors and assist the victims of a crime.
• Voting power: means the right vested by law or by the articles or the bylaws in the stockholder or in one or more classes of stockholder to vote in the determination of any particular question or matter coming before meetings of the stockholders. See Louisiana Revised Statutes 6:201
• warrantor: means a person who is contractually obligated to the warranty holder under the terms of the vehicle protection product warranty agreement. See Louisiana Revised Statutes 32:1272
• warranty: means a written agreement by a warrantor that provides if the vehicle protection product fails to prevent loss or damage to a vehicle from a specific cause, that the warrantor will pay to or on behalf of the warranty holder specified incidental costs as a result of the failure of the vehicle protection product to perform pursuant to the terms of the warranty. See Louisiana Revised Statutes 32:1272
• Warranty holder: means a person who purchases a vehicle protection product or who is a permitted transferee. See Louisiana Revised Statutes 32:1272
• Warranty reimbursement insurance policy: means a policy of insurance that is issued to the vehicle protection product warrantor to provide reimbursement to the warrantor or to pay on behalf of the warrantor all covered contractual obligations incurred by the warrantor under the terms and conditions of the insured vehicle protection product warranties issued by the warrantor. See Louisiana Revised Statutes 32:1272