Washington Code > Chapter 48.46 – Health maintenance organizations
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Terms Used In Washington Code > Chapter 48.46 - Health maintenance organizations
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- 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
- Carrier: means a health maintenance organization, an insurer, a health care services contractor, or other entity responsible for the payment of benefits or provision of services under a group or individual agreement. See Washington Code 48.46.020
- Census date: means the date upon which a health maintenance organization offering coverage to a small employer must base rate calculations. See Washington Code 48.46.020
- Commissioner: means the insurance commissioner. See Washington Code 48.46.020
- Comprehensive health care services: means basic consultative, diagnostic, and therapeutic services rendered by licensed health professionals together with emergency and preventive care, inpatient hospital, outpatient and physician care, at a minimum, and any additional health care services offered by the health maintenance organization. See Washington Code 48.46.020
- Consumer: means any member, subscriber, enrollee, beneficiary, or other person entitled to health care services under terms of a health maintenance agreement, but not including health professionals, employees of health maintenance organizations, partners, or shareholders of stock corporations licensed as health maintenance organizations. See Washington Code 48.46.020
- Contract: A legal written agreement that becomes binding when signed.
- Conviction: A judgement of guilt against a criminal defendant.
- Copayment: means an amount specified in a subscriber agreement which is an obligation of an enrolled participant for a specific service which is not fully prepaid. See Washington Code 48.46.020
- 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.
- Deductible: means the amount an enrolled participant is responsible to pay out-of-pocket before the health maintenance organization begins to pay the costs associated with treatment. See Washington Code 48.46.020
- Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
- Department: means the state department of social and health services. See Washington Code 48.46.020
- Dependent: A person dependent for support upon another.
- Enrolled participant: means a person who or group of persons which has entered into a contractual arrangement or on whose behalf a contractual arrangement has been entered into with a health maintenance organization to receive health care services. See Washington Code 48.46.020
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Fully subordinated debt: means those debts that meet the requirements of RCW 48. See Washington Code 48.46.020
- Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
- Group practice: means a partnership, association, corporation, or other group of health professionals:
Washington Code 48.46.020Health maintenance agreement: means an agreement for services between a health maintenance organization which is registered pursuant to the provisions of this chapter and enrolled participants of such organization which provides enrolled participants with comprehensive health services rendered to enrolled participants by health professionals, groups, facilities, and other personnel associated with the health maintenance organization. See Washington Code 48.46.020 Health maintenance organization: means any organization receiving a certificate of registration by the commissioner under this chapter which provides comprehensive health care services to enrolled participants of such organization on a group practice per capita prepayment basis or on a prepaid individual practice plan, except for an enrolled participant's responsibility for copayments and/or deductibles, either directly or through contractual or other arrangements with other institutions, entities, or persons, and which qualifies as a health maintenance organization pursuant to RCW 48. See Washington Code 48.46.020 Health professionals: means health care practitioners who are regulated by the state of Washington. See Washington Code 48.46.020 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 organization has been declared insolvent and is placed under an order of liquidation by a court of competent jurisdiction. See Washington Code 48.46.020 Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases. 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 Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity. Meaningful role in policy making: means a procedure approved by the commissioner which provides consumers or elected representatives of consumers a means of submitting the views and recommendations of such consumers to the governing board of such organization coupled with reasonable assurance that the board will give regard to such views and recommendations. See Washington Code 48.46.020 Mortgage: The written agreement pledging property to a creditor as collateral for a loan. Net worth: means the excess of total admitted assets as defined in RCW 48. See Washington Code 48.46.020 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. Participating provider: means a provider as defined in subsection (21) of this section who contracts with the health maintenance organization or with its contractor or subcontractor and has agreed to provide health care services to enrolled participants with an expectation of receiving payment, other than copayment or deductible, directly or indirectly, from the health maintenance organization. See Washington Code 48.46.020 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. person: may be construed to include the United States, this state, or any state or territory, or any public or private corporation or limited liability company, as well as an individual. See Washington Code 1.16.080 Provider: means any health professional, hospital, or other institution, organization, or person that furnishes any health care services and is licensed or otherwise authorized to furnish such services. See Washington Code 48.46.020 Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide. Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land. 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. 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. Statute: A law passed by a legislature. Subpoena: A command to a witness to appear and give testimony. Trustee: A person or institution holding and administering property in trust. Uncovered expenditures: means the costs to the health maintenance organization of health care services that are the obligation of the health maintenance organization for which an enrolled participant would also be liable in the event of the health maintenance organization's insolvency and for which no alternative arrangements have been made as provided herein. See Washington Code 48.46.020 Writ: A formal written command, issued from the court, requiring the performance of a specific act.