Section 89.201. Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

Act 81—The act of August 1, 1975 (P. L. 157, No. 81) (40 P. S. § § 753.1—753.4).

Coverage for newborn children—The same coverage provided under the terms of the form for dependent children for sickness, disease or injury. If the form does not provide coverage for dependent children, the coverage shall be the same as that provided the insured or subscriber. For purposes of compliance with Act 81, injury or sickness shall include medically diagnosed congenital defects, birth abnormalities, prematurity and routine nursery care. If the form provides coverage for routine well baby care, the same coverage shall be provided for newborn children. The coverage shall be provided regardless of whether the form provides for obstetrical coverage.

Insured or subscriber—A person, male or female, covered under the terms of a form to which Act 81 is applicable, regardless of the covered person’s marital or dependency status or eligibility for maternity benefits.

Routine nursery care—Hospital or other qualified health care institution, room, board or miscellaneous institutional care or care rendered by a licensed medical practitioner, performing within the scope of his license, associated with hospital confinement.

Routine well-baby care—Expense for which coverage is available under a form to a covered person for preventive health care, rendered either on an inpatient or outpatient basis, not associated with treatment of an ill or injured person, such as, but not limited to, immunizations, medical examinations or tests not necessary for the treatment of covered injuries, illnesses, birth defects, deformities or diseases, and hospital room, board or miscellaneous institutional expenses.