NAC695C.047. “Health service contract” defined.

“Health service contract” means an agreement between an organization and a delivery system intermediary in which the delivery system intermediary:

     1. Accepts risk from the organization in any form, including, without limitation, per capita payments and payments of a percentage of premiums, for one or more health care services which will be furnished to enrollees, members, policyholders or subscribers of the organization by a provider chosen by the delivery system intermediary and the delivery system intermediary assumes financial liability for the covered services; and

     2. Contracts with a provider to furnish one or more health care services to enrollees, members, policyholders or subscribers of the organization.

     (Added to NAC by Comm’r of Insurance by R129-96, eff. 10-29-97)