Sec. 38a-478. Definitions. - Connecticut Statutes

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

      (1) "Commissioner" means the Insurance Commissioner.

      (2) "Managed care organization" means an insurer, health care center, hospital or 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 pursuant to sections 38a-226 to 38a-226d, inclusive.

      (4) "Provider" means a person licensed to provide health care services under chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, inclusive, or chapter 400j.

      (5) Except as provided in sections 38a-478m and 38a-478n, "enrollee" means a person who has contracted for or who participates in a managed care plan for himself or his eligible dependents.

      (6) "Preferred provider network" means a preferred provider network, as defined in section 38a-479aa.

      (7) "Utilization review" means utilization review, as defined in section 38a-226.

      (8) "Utilization review company" means a utilization review company, as defined in section 38a-226.

      (P.A. 97-99, S. 1; P.A. 03-169, S. 10; P.A. 04-125, S. 2; P.A. 05-94, S. 5.)

      History: P.A. 03-169 added Subdivs. (6) to (8), defining "preferred provider network", "utilization review" and "utilization review company"; P.A. 04-125 redefined "provider" in Subdiv. (4) to reference "chapter 383c"; P.A. 05-94 redefined "enrollee" in Subdiv. (5) to add "Except as provided in sections 38a-478m and 38a-478n", effective July 1, 2005.