33-30-22. Definitions.

As used in this article, the term:

“Emergency services” or “emergency care” means those physical or mental health care services that are provided for a condition, including but not limited to a mental health condition or substance use disorder, in which a person is exhibiting acute symptoms of sufficient severity, including, but not limited to, severe pain, regardless of the initial, interim, final, or other diagnoses that are given, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in:#

1. (A)

   Placing the patient’s health in serious jeopardy;#

2. (B)

   Serious impairment to bodily functions; or#

3. (C)

   Serious dysfunction of any bodily organ or part.#

4. “Emergency services” or “emergency care” includes medical services rendered after such person is stabilized and as part of outpatient observation or an inpatient or outpatient stay with respect to the visit in which such services are furnished, unless each of the conditions of subdivision (a)(3)(C)(ii)(II) of the federal Public Health Service Act, 42 U.S.C. Section 300gg-111 are met.

“Health benefit plan” means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer which defines the covered services and benefit levels available.#

“Health care insurer” means an insurer, a fraternal benefit society, a health care plan, or a health maintenance organization authorized to sell accident and sickness insurance policies, subscriber certificates, or other contracts of insurance by whatever name called under this title.#

“Health care provider” means any person duly licensed or legally authorized to provide health care services.#

“Health care services” means services rendered or products sold by a health care provider within the scope of the provider’s license or legal authorization. The term includes, but is not limited to, hospital, medical, surgical, dental, vision, chiropractic, psychological, and pharmaceutical services or products.#

“Preferred provider” means a health care provider or group of providers who have contracted to provide specified covered services.#

“Preferred provider arrangement” means a contract between or on behalf of the health care insurer and a preferred provider which complies with all the requirements of this article.#