Subdivision 1. Applicability.
For purposes of sections
, the following
Subd. 2. Contract.
"Contract" means a written agreement between a health care provider
and a health plan company to provide health care services.
Subd. 3. Health care provider or provider.
"Health care provider" or "provider" means a
physician, chiropractor, dentist, podiatrist, or other provider as defined under section
than hospitals, ambulatory surgical centers, or freestanding emergency rooms.
Subd. 4. Health plan company.
(a) "Health plan company" means:
(1) a health maintenance organization operating under chapter 62D;
(2) a community integrated service network operating under chapter 62N;
(3) a preferred provider organization as defined in section
145.61, subdivision 4c
(4) an insurance company licensed under chapter 60A, nonprofit health service corporation
operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other
entity that establishes, operates, or maintains a health benefit plan or network of health care
providers where the providers have entered into a contract with the entity to provide health
(b) This subdivision does not apply to a health plan company with respect to coverage
described in section
62A.011, subdivision 3
, clauses (1) to (5) and (7) to (12).
Subd. 5. Fee schedule.
"Fee schedule" means the total expected financial compensation paid
to a health care provider for providing a health care service as determined by the contract between
the health plan company and the provider, inclusive of withhold amounts and any amount for
which the patient or other third party may be obligated to pay under the contract.
History: 2004 c 246 s 3