Terms Used In Rhode Island General Laws 27-41-26

• Covered health services: means the services that a health maintenance organization contracts with enrollees and enrolled groups to provide or make available to an enrolled participant. See Rhode Island General Laws 27-41-2
• Enrollee: means an individual who has been enrolled in a health maintenance organization. See Rhode Island General Laws 27-41-2
• Health maintenance organization: means a single public or private organization which:

  (1)  Provides or makes available to enrolled participants healthcare services, including at least the following basic healthcare services: usual physician services, hospitalization, laboratory, x-ray, emergency, and preventive services, and out of area coverage, and the services of licensed midwives;

  (2)  Is compensated, except for copayments, for the provision of the basic healthcare services listed in subdivision (1) of this subsection to enrolled participants on a predetermined periodic rate basis; and

  (3)(i)  Provides physicians' services primarily:

  (A)  Directly through physicians who are either employees or partners of the organization; or

  (B)  Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis;

  (ii)  "Health maintenance organization" does not include prepaid plans offered by entities regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not purport to be health maintenance organizations;

  (4)  Provides the services of licensed midwives primarily:

  (i)  Directly through licensed midwives who are either employees or partners of the organization; or

  (ii)  Through arrangements with individual licensed midwives or one or more groups of licensed midwives organized on a group practice or individual practice basis. See Rhode Island General Laws 27-41-2

• provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-41-2