As used in the Out-of-Network Ambulance Service Provider Act: 1. “Ambulance service provider” means an ambulance service as defined by Section 1-2503 of Title 63 of the Oklahoma Statutes except that, for the purposes of this act, the term shall be limited to an ambulance service provider that provides ground transportation services; 2. “Covered ambulance services” means those ground ambulance services which an enrollee is entitled to receive under the terms of a health care benefit plan; 3. “Enrollee” means a person who is entitled to receive covered ambulance services under the terms of a health care benefit plan; 4. “Health care benefit plan” means a plan, policy, contract, certificate, agreement, or other evidence of coverage for health care services offered, issued, renewed, or extended in this state by a health care insurer, or government-sponsored self-insured plans. Health care benefit plan does not include any health plan offered by a contracted entity as defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides coverage to members of the state Medicaid program; 5. “Health care insurer” means an entity that is subject to state insurance regulation and provides coverage for health benefits in this state and includes the following: a. an insurance company, b. a health maintenance organization, c. a hospital and medical service corporation, d. a risk-based provider organization, or e. a sponsor or self-funded plan. Health care insurer does not include a contracted entity as defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides coverage to members of the state Medicaid program; 6. “Out-of-network” means a provider that does not contract with the health care insurer of the enrollee receiving the covered ambulance services; and 7. “Clean claim” means a claim that has no defect of impropriety, including any lack of required substantiating documentation or particular circumstances requiring special treatment that prevents timely payment from being made on the claim.
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