(b) Director shall mean the Director of the Department of
Public Health and Social Services;

(c) Health care insurer shall mean a self-insured health benefit plan, a group health plan as defined in Section 607(1) of the Employment Retirement Income Security Act of 197 4, a pharmacy benefit manager or any other party that by statute, contract or agreement is responsible for paying for items or services provided to an eligible person under this Act.

(d) Health care services includes products provided or purchased through an approved facility.

(e) Insurance, medical service, or health plan includes a

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preferred provider organization, an insurance plan described as Medicare supplemental insurance, and a personal injury protection plan or medical payments benefit plan for personal injuries resulting from the operation of a motor vehicle.

(f) Private insurer means:

(1) any commercial insurance company offering health or casualty insurance to individuals or groups (including both experience-rated insurance contracts and indemnity contracts);

(2) any profit or nonprofit prepaid plan offering either medical services or full or partial payment for services induded in the state plan; and

(3) any organization administering health or casualty insurance plans for professional associations, unions, fraternal groups, employer-employee benefit plans, and any similar organization offering these payments or services, including selfinsured and self-funded plans.

(g) Third party payer means an entity that provides an insurance, medical service, or health plan by contract or agreement, including an automobile liability insurance or no fault insurance carrier, and any other plan or program that is designed to provide compensation or coverage for expenses incurred by a beneficiary for health care services or products.

(h) Title N-D agency means the organizational unit in the state that has the responsibility for administering or supervising the administration of a state plan for child support enforcement under Title IV-D of the Act.

SOURCE: Added by P.L. 32-183:2 (Oct. 13, 2014).

§ 21204. State Plan Requirements.
The Division of Social Services State Plan must provide for: (a) identifying third parties liable for payment of
services under the plan and for payment of claims involving
third parties;

(b) assignment of rights to benefits, cooperation with the agency in obtaining medical support or payments, and

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cooperation in identifying and providing information to assist the state in pursuing any liable third parties; and

(c) assuring the requirements for cooperative agreements and incentive payments for third party collections are met.

SOURCE: Added by P.L. 32-183:2 (Oct. 13, 2014).

2017 NOTE: Subsection designations altered/added pursuant to the authority of 1 Guam Code Ann. § 1606.