Sec. 107.
(1) “Participating provider” means a provider that has entered into a participating contract with a health care corporation and that meets the standards set by the corporation for that class of providers.
(2) “Participating contract” means an agreement, contract, or other arrangement under which a provider agrees to accept the payment of the health care corporation as payment in full for health care services or parts of health care services covered under a certificate, as provided for in section 502(1).
(3) “Person” means an individual, corporation, partnership, organization, or association.
(4) “Personal data” means a document incorporating medical or surgical history, care, treatment, or service; or any similar record, including an automated or computer accessible record, relative to a member, which is maintained or stored by a health care corporation.
(5) “Proposed rate” means any of the following:
(a) A proposed increase or decrease in the rates to be charged to nongroup subscribers.
(b) For group subscribers, any proposed changes in the methodology or definitions of any rating system, formula, component, or factor subject to prior approval by the commissioner.
(c) A proposed increase or decrease in deductible amounts or coinsurance percentages.
(d) A proposed extension of benefits, additional benefits, or a reduction or limitation in benefits.
(e) A review pursuant to section 608(2).
(6) “Provider class” means classes of providers, as defined in section 105(4), that have a provider contract or a reimbursement arrangement with a health care corporation to render health care services to subscribers, as those classes are established by the corporation.
(7) “Provider class plan” or “plan” means a document containing a reimbursement arrangement and objectives for a provider class, and, in the case of those providers with which a health care corporation contracts, provisions that are included in that contract.
(8) “Provider contract” or “contract” means an agreement between a provider and a health care corporation that contains provisions to implement the provider class plan.
History: 1980, Act 350, Eff. Apr. 3, 1981
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350
Last modified: October 10, 2016