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Connecticut General Statutes Title 38A. Insurance § 38a-478. Definitions

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As used in this section, sections 38a-478a to 38a-478o, inclusive, and subsection (a) of section 38a-478s:

(1) “Commissioner” means the Insurance Commissioner.

(2) “Covered benefit” or “benefit” means a health care service to which an enrollee is entitled under the terms of a health benefit plan.

(3) “Enrollee” means a person who has contracted for or who participates in a managed care plan for such person or such person's eligible dependents.

(4) “Health care services” means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease.

(5) “Managed care organization” means an insurer, health care center, hospital service corporation, medical service corporation or other organization delivering, issuing for delivery, renewing, amending or continuing any individual or group health managed care plan in this state.

(6) “Managed care plan” means a product offered by a managed care organization that provides for the financing or delivery of health care services to persons enrolled in the plan through:  (A) Arrangements with selected providers to furnish health care services;  (B) explicit standards for the selection of participating providers;  (C) financial incentives for enrollees to use the participating providers and procedures provided for by the plan;  or (D) arrangements that share risks with providers, provided the organization offering a plan described under subparagraph (A), (B), (C) or (D) of this subdivision is licensed by the Insurance Department pursuant to chapter 698,   1 698a   2 or 700   3 and the plan includes utilization review, as defined in section 38a-591a.

(7) “Preferred provider network” has the same meaning as provided in section 38a-479aa.

(8) “Provider” or “health care provider” means a person licensed to provide health care services under chapters 370 to 373, inclusive,   4 375 to 383c, inclusive,   5 384a to 384c, inclusive,   6 or chapter 400j.   7

(9) “Utilization review” has the same meaning as provided in section 38a-591a.

(10) “Utilization review company” has the same meaning as provided in section 38a-591a.

1  C.G.S.A. § 38a-41 et seq.
2  C.G.S.A. § 38a-175 et seq.
3  C.G.S.A. § 38a-305 et seq.
4  C.G.S.A. § 20-8 et seq. to § 20-34 et seq., inclusive.
5  C.G.S.A. § 20-50 et seq. to § 20-195aa et seq., inclusive.
6  C.G.S.A. § 20-206a et seq. § 20-206aa et seq., inclusive.
7  C.G.S.A. § 20-570 et seq.

Cite this article: - Connecticut General Statutes Title 38A. Insurance § 38a-478. Definitions - last updated June 28, 2021 |

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