Alaska Statutes-Title 21-Chapter 07. Patient Protections Under Health Care Insurance Policies

(1) [Repealed, § 65 ch 41 SLA 2016.]

(2) [Repealed, § 65 ch 41 SLA 2016.]

(3) “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, that a prudent person who possesses an average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention would result in serious impairment of bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy.

(4) “emergency services” means medical care services or items furnished or required to evaluate and treat an emergency medical condition;

(5) “health care insurer” has the meaning given in AS 21.54.500;

(6) “health care provider” means a person licensed in this state or another state of the United States to provide medical care services;

(7) “health insurance” has the meaning given in AS 21.12.050(a);

(8) [Repealed, § 65 ch 41 SLA 2016.]

(9) “medical care” has the meaning given in AS 21.97.900;

(10) “participating health care provider” means a health care provider who has entered into an agreement with a health care insurer to provide services or supplies to a patient covered by a health care insurance policy;

(11) “primary care provider” means a health care provider who provides general medical care services and does not specialize in treating a single injury, illness, or condition or who provides obstetrical, gynecological, or pediatric medical care services;

(12) “provider” means a health care provider;

(13) “religious nonmedical provider” means a person who provides only religious nonmedical treatment or nursing care for an illness or injury;

(14) “utilization review” means a set of techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings; techniques may include ambulatory review, prospective review, second opinion certification, concurrent review, case management, discharge planning, or retrospective review.

(15)  "chronic condition" means a medical condition or disease expected to last at least 12 months or expected to persist over the lifetime of an individual, requiring ongoing medical care to manage symptoms or prevent progression; 

(16)  "covered person" means a policyholder, subscriber, enrollee, or 6 other individual participating in a health care insurance policy; 

(17) "expedited request" means a request by a health care provider for approval of medical care or a prescription drug when the covered person is undergoing a current course of treatment using a nonformulary drug or for which the passage of time:

(A) could jeopardize the life or health of the covered person;  

(B) could jeopardize the ability of a covered person to regain maximum function; or 

(C) would, as determined by a health care provider with knowledge of the covered person's medical condition, subject the covered person to severe pain that cannot be adequately managed without the medical care or prescription drug that is the subject of the request; 

(18) "prior authorization" means the process used by a health care insurer to determine the medical necessity or medical appropriateness of covered medical care before the medical care is provided;

(19) "standard request" means a request by a health care provider for approval of medical care or a prescription drug for which the request is made in advance of the covered person's obtaining medical care or a prescription drug that is 24 not required to be expedited; 

(20) "step therapy protocol" means a protocol, policy, or program used by a health care insurer or utilization review organization that establishes which prescription drugs are medically appropriate for a particular covered person and the specific sequence in which the prescription drugs should be administered for a specified medical condition, whether by self-administration or administration by a health care provider, under a pharmacy or medical benefit of a health care insurance "utilization review organization" means an entity, other than a health care insurer performing utilization review for the health care insurer's own health insurance policy, that conducts any part of utilization review.

See https://law.justia.com/codes/alaska/title-21/chapter-07/section-21-07-250/