1. As used in this act:
a. “Commissioner” means the Commissioner of Banking and Insurance.
b. “Board” and “board of directors” means the board of directors of the health service corporation.
C. “Elective surgical procedure” means any nonemergency surgical procedure which may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient’s life or causing serious impairment to the patient’s bodily functionS.
d. “Eligible physician” means a physician licensed to practice medicine and surgery who holds the rank of Diplomate of an American Board (M.D.) or Certified Specialist (D.O.) in the surgical or medical specialty for which surgery is proposed.
e. “Health service corporation” means a health service corporation established pursuant to the provisions of this act, which is organized, without capital stock and not for profit, for the purpose of (1) establishing, maintaining, and operating a nonprofit health service plan and (2) supplying services in connection with (a) the providing of health care or (b) conducting the business of insurance as provided for in this act.
f. “Health service plan” means a plan under which contracts are issued providing complete or partial prepayment or postpayment of health care services and supplies eligible under the contracts for a given period to persons covered under the contracts where arrangements are made for payment for health care services and supplies directly to the provider thereof or to a covered person under those contractS.
g. “Hospital service corporation” means a hospital service corporation established pursuant to the provisions of P.L.1938, C. 366 (C. 17:48-1 et seq.).
h. “Medical service corporation” means a medical service corporation established pursuant to the provisions of P.L.1940, C. 74 (C. 17:48A-1 et seq.).
i. “Provider of health care services” shall include, but not be limited to: (1) a health service corporation, a hospital service corporation or medical service corporation; (2) a hospital or health care facility under contract with a health service corporation to provide health care services or supplies to persons who become subscribers under contracts with the health service corporation; (3) a hospital or health care facility which is maintained by a state or any of its political subdivisions; (4) a hospital or health care facility licensed by the Department of Health; (5) other hospitals or health care facilities, as designated by the Department of Health to provide health care services; (6) a registered nursing home providing convalescent care; (7) a nonprofit voluntary visiting nurse organization providing health care services other than in a hospital; (8) hospitals or other health care facilities located in other states, which are subject to the supervision of those states, which if located in this State would be eligible to be licensed or designated by the Department of Health; (9) nonprofit hospital, medical or health service plans of other states approved by the commissioner; (10) physicians licensed to practice medicine and surgery; (11) licensed chiropractors; (12) licensed dentists; (13) licensed optometrists; (14) licensed pharmacists; (15) licensed podiatrists; (16) registered bio-analytical laboratories; (17) licensed psychologists; (18) registered physical therapists; (19) certified nurse-midwives; (20) registered professional nurses; (21) licensed health maintenance organizations; (22) licensed audiologists; (23) licensed speech-language pathologists; and (24) providers of other similar health care services or supplies as are approved by the commissioner.
j. “Second surgical opinion” means an opinion of an eligible physician based on that physician’s examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure, but prior to the performance of the surgical procedure.
k. “Subscriber” means a person to whom a subscription certificate is issued by a health service corporation, and the term shall also include “policyholder,” “member,” or “employer” under a group contract where the context requireS.
L.1985, C. 236, S.1; amended 1997, C. 419, S.1; 2005, C. 259, S.27; 2012, C. 17, S.37.
Original Text maintained by the State of New Jersey:
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