§ 417.1 Definitions.

As used in this part, unless the context indicates otherwise—

Basic health services means health services described in § 417.101(a).

Community rating system means a system of fixing rates of payments for health services that meets the requirements of § 417.104(a)(3).

Comprehensive health services means as a minimum the following services which may be limited as to time and cost:

(1) Physician services (§ 417.101(a)(1));

(2) Outpatient services and inpatient hospital services (§ 417.101(a)(2));

(3) Medically necessary emergency health services (§ 417.101(a)(3)); and

(4) Diagnostic laboratory and diagnostic and therapeutic radiologic services (§ 417.101(a)(6)).

Direct service contract means a contract for the provision of basic or supplemental health services or both between an HMO and (1) a health professional other than a member of the staff of the HMO, or (2) an entity other than a medical group or an IPA.

Enrollee means an individual for whom an HMO, CMP, or HCPP assumes the responsibility, under a contract or agreement, for the furnishing of health care services on a prepaid basis.

Full-time student means a student who is enrolled for a sufficient number of credit hours in a semester or other academic term to enable the student to complete the course of study within not more than the number of semesters or other academic terms normally required to complete that course of study on a full-time basis at the school in which the student is enrolled.

Furnished, when used in connection with prepaid health care services, means services that are maid available to an enrollee either dierctly by, or under arrangements made by, the HMO, CMP, or HCPP.

Health maintenance organization (HMO) means a legal entity that provides or arranges for the provision of basic and supplemental health services to its enrollees in the manner prescribed by, is organized and operated in the manner prescribed by, and otherwise meets the requirements of, section 1301 of the PHS Act and the regulations in subparts B and C of this part.