Guam § 21203 - Definitions.

§ 21203. Definitions.

(a) “DPHSS” shall mean the Department of Public Health and Social Services;

(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 1974, 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 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 included 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 self-insured 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.