Fla. Admin. Code Ann. R. 59B-14.002 - Definitions
(1) "Health plan" means a health benefit plan
as defined in Section
627.6699(3)(k),
F.S., that is, any hospital or medical policy or certificate, hospital or
medical service plan contract, or health maintenance organization subscriber
contract. The term does not include accident-only, specified disease,
individual hospital indemnity, credit, dental-only, vision-only, Medicare
supplement, long-term care, or disability income insurance; similar
supplemental plans provided under a separate policy, certificate, or contract
of insurance, which cannot duplicate coverage under an underlying health plan
and are specifically designed to fill gaps in the underlying health plan,
coinsurance, or deductibles; coverage issued as a supplement to liability
insurance; workers' compensation or similar insurance; or automobile
medical-payment insurance. The term does not include Medicare health plans,
Medicaid health plans, or Florida Healthy Kids health plans described in
Section 624.91, F.S. The term does not
include limited or short term hospital, medical or surgical benefit
policies.
(2) "Measurement year"
means the year prior to the year in which the report is due to be submitted to
the Agency for Health Care Administration (agency).
(3) "Insured" means a person who has health
care coverage under a health plan of the health insurer.
(4) "Covered lives" means the sum of primary
insureds (the total number of resident individual policyholders or resident
group employee or member certificateholders) and covered dependents (the total
number of individuals who are covered by the primary insured's plan and who
receive coverage due to his or her dependent relationship to the primary
insured).
(5) "Cost sharing" means
any co-insurance, co-payment, deductible or similar arrangement the member
agrees to pay upon receipt of covered health care
services.
Notes
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061(1)(c), (e) FS.
New 12-25-05.
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