R.C.S.A. § 38a-554-2
Definitions
Cite as Conn. Agencies Regs. § 38a-554-2
(A) "Plan" means any group policy issued by or reinsured through the Health Reinsurance
Association or any subscriber contract issued by a residual market mechanism established
by hospital and medical service corporations and providing comprehensive health care
coverage as provided in Chapter 700c of the Connecticut General Statutes.
The term "Plan" shall be construed separately with respect to each policy, contract,
or other arrangement for benefits or services and separately with respect to that
portion of any such policy, contract, or other arrangement which reserves the right
to take the benefits or services of other Plans into consideration in determining
its benefits and that portion which does not.
(B) "This Plan" means those portions of the policy which provide the benefits that
are subject to this provision.
(C) "Allowable Expense" means any necessary, reasonable, and customary item of expense
at least a portion of which is covered under at least one of the Plans covering the
person for whom claim is made.
When a Plan provides benefits in the form of services rather than cash payments, the
reasonable cash value of each service rendered shall be deemed to be both an Allowable
Expense and a benefit paid.
(D) "Claim Determination Period" means a calendar year, or that portion of a calendar
year during which the person for whom claim is made has been covered under this Plan.