§1260.2. Definitions
As used in this Subpart, unless the context clearly indicates otherwise, the following
definitions shall apply:
(1) "Affiliate" shall mean a person that, directly or indirectly through one or more
intermediaries, controls or is controlled by or is under common control with an insurance
company or health maintenance organization licensed by this state.
(2) "Commissioner" shall mean the commissioner of insurance.
(3) "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.
(4) "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. This term shall not include any plan that does not charge
a membership or other fee to use the plan's discount medical card or discount medical plan
provided by an insurer or health maintenance organization where the discount plan is
provided at no cost to the insured or member and is offered due to coverage with the insurer
or health maintenance organization. This term shall not include any agreements related to
medical services which are provided to injured workers under the requirements of Chapter
10 of Title 23 of the Louisiana Revised Statutes of 1950, or ambulance membership service
agreements.
(5) "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. Entities that are licensed pursuant
to this Title shall not be subject to the provisions of R.S. 22:2393, 2394 and 2398.
(6) "Discount medical plan provider" shall mean any person that has contracted
directly or indirectly with a discount medical plan organization to provide medical services.
(7) "Entity" shall mean a corporation, association, partnership, limited liability
company, limited liability partnership or other legal entity.
(8) "Facility" shall mean an institution providing medical services or a health care
setting, to include, but not be limited to, a hospital or other licensed inpatient center, an
ambulatory surgical or treatment center, a skilled nursing center, a residential treatment
center, a rehabilitation center and a diagnostic, laboratory or imaging center.
(9) "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.
(10) "Health care provider network" shall mean an entity which directly or indirectly
contracts with a health care provider and has contractual rights to negotiate on behalf of those
health care providers with a discount medical plan organization to provide medical services
to members of a discount medical plan.
(11) "Individual" shall mean a natural person.
(12) "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.
(13) "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.
(14) "Member" shall mean any individual who pays valuable consideration to receive
the purported benefits of a discount medical plan.
(15) "Person" shall mean an individual or an entity.
Acts 2008, No. 442, §1, eff. Jan. 1, 2009; Redesignated by Acts 2009, No. 503, §3.