Pennsylvania Statutes Title 40 P.S. Insurance § 991.2301-A. Definitions

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“Child.” An individual under 19 years of age.

“Contractor.” An insurer awarded a contract under section 2304-A  1 to provide health care services under this article. The term includes an entity and an entity's subsidiary which is established under this act, 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations) or the act of December 29, 1972 (P.L. 1701, No. 364),  2 known as the Health Maintenance Organization Act.

“Council.” The Children's Health Advisory Council established in section 2303-A.  3

“Department.” The Department of Human Services of the Commonwealth.

“EPSDT.” Early and periodic screening, diagnosis and treatment.

“Express lane eligibility.” A process which permits the use of findings for eligibility factors, including income and household size from an express lane partner administering a government program.

“Express lane partner.” An agency determining eligibility for assistance for any of the following programs:

(1) Supplemental Nutrition Assistance Program (SNAP).

(2) Child care provided under the Child Care and Development Block Grant Act of 1990 (Public Law 101-508, 42 U.S.C. § 9858 et seq.).

“Fund.” The Children's Health Fund.

“Group.” A group for which a health insurance policy is written in this Commonwealth.

“Health service corporation.” A professional health service corporation as defined in section 2302-A.  4

“Healthy Beginnings Program.” Medical assistance coverage for services to children as required under Title XIX  5 for the following:

(1) Children from birth to one year of age whose family income is not greater than 185% of the Federal poverty level.

(2) Children one through five years of age whose family income is not greater than 133% of the Federal poverty level.

(3) Children 6 through 18 years of age whose family income is not greater than 133% of the Federal poverty level.

“HMO.” An entity organized and regulated under the act of December 29, 1972 (P.L. 1701, No. 364) known as the Health Maintenance Organization Act.

“Hospital.” An institution having an organized medical staff which is engaged primarily in providing to inpatients, by or under the supervision of physicians, diagnostic and therapeutic services for the care of injured, disabled, pregnant, diseased or sick or mentally ill individuals. The term includes facilities for the diagnosis and treatment of disorders within the scope of specific medical specialties. The term does not include facilities caring exclusively for the mentally ill.

“Hospital plan corporation.” A hospital plan corporation as defined in 40 Pa.C.S. § 6101 (relating to definitions).

“Insurer.” A health insurance entity licensed in this Commonwealth to issue any individual or group health, sickness or accident policy or subscriber contract or certificate that provides medical or health care coverage by a health care facility or licensed health care provider that is offered or governed under any of the following:

(1) This act.

(2) The act of December 29, 1972 (P.L.1701, No.364) known as the Health Maintenance Organization Act.

(3) The act of May 18, 1976 (P.L. 123, No. 54),  6 known as the Individual Accident and Sickness Insurance Minimum Standards Act.

(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations).

“Medicaid.” The Federal medical assistance program established under Title XIX.

“Medical assistance.” The State program of medical assistance established under the act of June 13, 1967 (P.L. 31, No. 21),  7 known as the Public Welfare Code.

“Mid-level health professional.” A physician assistant, certified registered nurse practitioner, nurse practitioner or certified nurse midwife.

“Parent.” A natural parent, stepparent, adoptive parent, guardian or custodian of a child.

“Premium assistance program.” A component of a separate child health program, approved under the State plan, under which the Commonwealth pays part or all of the premium for an enrollee or enrollee's group health insurance coverage or coverage under a group health plan.

“Prescription drug.” A controlled substance, other drug or device for medication dispensed by order of an appropriately licensed medical professional.

“Secretary.” The Secretary of Human Services of the Commonwealth.

“Terminate.” The term includes cancellation, nonrenewal and rescission.

“Title XIX.” Title XIX  8 of the Social Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.).

“Title XXI.” Title XXI  9 of the Social Security Act.