Policy Definitions

For purposes of sections 38a-472f-2 to 38a-472f-5, inclusive, of the Regulations of Connecticut State Agencies: (1) "Ancillary service" means a health care service that is not provided as part of an office visit, outpatient procedure or hospital admission, but for which a patient presents at a separate facility or site of service. (2) "Primary care physician" means a participating health care provider designated by a health carrier to supervise, coordinate or provide initial health care services or continuing health care services to a covered person, and who may be required by the health carrier to initiate a referral for specialty care and maintain supervision of health care services provided to the covered person. (3)(A) "Specialist” means a health care provider who (i) focuses on a specific area of physical, mental or behavioral health or a specific group of patients, and (ii) has successfully completed required training and is recognized by this state to provide specialty care. (B) “Specialist” includes a subspecialist who has additional training and recognition beyond that required for a specialist. (4) “Urgent care" means a condition, other than an emergency condition, manifesting itself by acute symptoms of sufficient severity that, in the assessment of a prudent layperson possessing an average knowledge of medicine and health, could reasonably be expected to result in serious impairment of bodily functions, serious dysfunction of a bodily organ or a body part, or one's mental ability, or any other condition that would place the health or safety of the covered person in serious jeopardy in the absence of treatment within twenty-four (24) hours.