Louisiana § RS 22:1171 - Short title; definitions

§ RS 22:1171. Short title; definitions

            A. This Subpart may be cited as the "Network Leasing Act".

            B. As used in this Subpart, the following definitions apply:

            (1) "Contracting entity" means any person or entity, including a third-party administrator and a dental carrier, that enters into a direct contract with a provider for the delivery of dental services in the ordinary course of business.

            (2) "Dental benefit plan" means a benefit plan which pays or provides dental expense benefits for covered dental services and is delivered or issued for delivery by or through a dental carrier on a stand-alone basis.

            (3) "Dental carrier" means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services.

            (4) "Dental services" means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease. "Dental services" does not include services delivered by a provider that are billed as medical expenses per the terms of a health insurance plan.

            (5) "Dentist" means any person lawfully licensed by the Louisiana State Board of Dentistry to practice dentistry in this state.

            (6) "Health insurance plan" means any hospital or medical insurance policy or certificate, qualified higher deductible health plan, health maintenance organization subscriber contract, contract providing benefits for dental care whether such contract is pursuant to a medical insurance policy or certificate, stand-alone dental plan, health maintenance provider contract, or managed healthcare plan.

            (7) "Health insurer" means any entity or person that issues health insurance plans as described in this Section.

            (8) "Provider" means an individual or entity which, acting within the scope of licensure or certification, provides dental services or supplies defined by the health insurance plan or dental benefit plan. "Provider" does not include a physician organization or physician hospital organization that leases or rents the physician organization's or physician hospital organization's network to a third party.

            (9) "Provider network contract" means a contract between a contracting entity and a provider that specifies the rights and responsibilities of the contracting entity and provides for the delivery and payment of dental services to an enrollee.

            (10) "Third party" means a person or entity that enters into a contract with a contracting entity or with another third party to gain access to the dental services or contractual discounts of a provider network contract. "Third party" does not include an employer or other group for whom the dental carrier or contracting entity provides administrative services.

            Acts 2021, No. 26, §1.