(a)
(1) “Copayment” means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of healthcare costs with their healthcare insurer paying the remainder of the charge.
(2) The copayment is incurred at the time the service is rendered.
(3) The copayment may be a fixed or variable amount.
(b) “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.
(c) “Health benefit plan” means any entity or program that provides reimbursement, including capitation, for healthcare services, except and excluding any entity or program that provides reimbursement and benefits pursuant to Arkansas Constitution, Amendment 26, Acts 1993, No. 796, or the Public Employee Workers' Compensation Act, § 21-5-601 et seq., and rules and schedules adopted thereunder.
(d) “Healthcare provider” means those individuals or entities licensed by the State of Arkansas to provide healthcare services, limited to the following:
(1) Advanced practice nurses;
(2) Athletic trainers;
(3) Audiologists;
(4) Certified behavioral health providers;
(5) Certified orthotists;
(6) Chiropractors;
(7) Community mental health centers or clinics;
(8) Dentists;
(9) Home health care;
(10) Hospice care;
(11) Hospital-based services;
(12) Hospitals;
(13) Licensed ambulatory surgery centers;
(14) Licensed certified social workers;
(15) Licensed dieticians;
(16) Licensed intellectual and developmental disabilities service providers;
(17) Licensed professional counselors;
(18) Licensed psychological examiners;
(19) Long-term care facilities;
(20) Occupational therapists;
(21) Optometrists;
(22) Pharmacists;
(23) Physical therapists;
(24) Physicians and surgeons (M.D. and D.O.);
(25) Podiatrists;
(26) Prosthetists;
(27) Psychologists;
(28) Respiratory therapists;
(29) Rural health clinics; and
(30) Speech pathologists.
(e) “Healthcare services” means services and products provided by a healthcare provider within the scope of the healthcare provider's license.
(f) “Healthcare insurer” means any entity, including, but not limited to:
(1) Insurance companies;
(2) Hospital and medical service corporations;
(3) Health maintenance organizations;
(4) Preferred provider organizations;
(5) Physician hospital organizations;
(6) Third-party administrators; and
(7) Prescription benefit management companies,
authorized to administer, offer, or provide health benefit plans.
Structure Arkansas Code