Connecticut § 38a-1040 Definitions.

Connecticut Statutes

§ 38a-1040 — Definitions.

Connecticut·Title 38a Insurance·Ch. 706b Office of the Healthcare Advocate and Office of the Behavioral Health Advocate

As used in sections 38a-1040 to 38a-1050, inclusive:

(1)“Consumer” means an individual who receives or is attempting to receive services from a managed care organization and is a resident of this state.

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

(3)“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 provide

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As used in sections 38a-1040 to 38a-1050, inclusive: (1) “Consumer” means an individual who receives or is attempting to receive services from a managed care organization and is a resident of this state. (2) “Managed care organization” means an insurer, health care center, hospital service corporation, medical service corporation or other organization delivering, issuing for delivery, renewing or amending any individual or group health managed care plan in this state. (3) “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, 698a or 700 and that the plan includes utilization review, as defined in section 38a-591a .

Connecticut § 38a-1040 (Definitions.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

(P.A. 99-284, S. 1; P.A. 11-58, S. 86; P.A. 15-118, S. 24.) History: P.A. 11-58 replaced reference to Secs. 38a-226 to 38a-226d with “as defined in section 38a-591a” in Subdiv. (3), effective July 1, 2011; P.A. 15-118 made a technical change in Subdiv. (2).