North Dakota Code 26.1-47-01 – Definitions
As used in this chapter, unless the context indicates otherwise:
Terms Used In North Dakota Code 26.1-47-01
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Individual: means a human being. See North Dakota Code 1-01-49
- Organization: includes a foreign or domestic association, business trust, corporation, enterprise, estate, joint venture, limited liability company, limited liability partnership, limited partnership, partnership, trust, or any legal or commercial entity. See North Dakota Code 1-01-49
- Person: means an individual, organization, government, political subdivision, or government agency or instrumentality. See North Dakota Code 1-01-49
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- written: include "typewriting" and "typewritten" and "printing" and "printed" except in the case of signatures and when the words are used by way of contrast to typewriting and printing. See North Dakota Code 1-01-37
1. “Air ambulance” means a specially equipped aircraft licensed by the department of health and human services for transporting patients.
2. “Air ambulance provider” means a publicly or privately owned organization that is licensed or applies for licensure by the department of health and human services to provide transportation and care of patients by air ambulance.
3. “Authorized representative” means:
a. A person to which a covered person has given express written consent to represent the covered person; b. A person authorized by law to provide substituted consent for a covered person; or c. If a covered person is unable to provide consent, the covered person’s treating health care professional or a family member of the covered person.
4. “Balance billing” means the practice of an air ambulance provider billing for the difference between the air ambulance provider’s charge and the health care insurer’s allowed amount.
5. “Commissioner” means the insurance commissioner of the state of North Dakota.
6. “Covered person” means an individual on whose behalf the health care insurer is obligated to pay for or provide health care services.
7. “Facility” means an institution or other immobile health care setting providing physical, mental, or behavioral health care services.
8. “Health benefit plan” means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer which defines the services covered.
9. “Health care insurer” includes an insurance company as defined in section 26.1-02-01, a health service corporation as defined in section 26.1-17-01, a health maintenance organization as defined in section 26.1-18.1-01, and a fraternal benefit society as defined in section 26.1-15.1-02.
10. “Health care provider” means licensed providers of health care services in this state.
11. “Health care services” means services rendered or products sold by a health care provider within the scope of the provider’s license. The term includes hospital, medical, surgical, dental, vision, chiropractic, and pharmaceutical services or products.
12. “Network” means a group of preferred providers providing services under a network plan.
13. “Network plan” means a health benefit plan that requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed by, owned by, under contract with, or employed by the health care insurer.
14. “Out-of-network” means a provider that is not providing the service under a network plan.
15. “Preferred provider” means a duly licensed health care provider or group of providers who have contracted with the health care insurer, under this chapter, to provide health care services to covered persons under a health benefit plan.
16. “Preferred provider arrangement” means a contract between the health care insurer and one or more health care providers which complies with all the requirements of this chapter.
17. “Prior authorization” means confirmation by the covered person’s health care insurer that the air ambulance services sought to be provided by the air ambulance provider meet the criteria for coverage under the covered person’s health benefit plan as defined by the provisions of the covered person’s health benefit plan.