Sec. 17b-290. Definitions.
Sec. 17b-290. Definitions. As used in sections 17b-289 to 17b-303, inclusive, and
section 16 of public act 97-1 of the October 29 special session*:
(1) "Applicant" means an individual over the age of eighteen years who is a natural
or adoptive parent or a legal guardian; a caretaker relative, foster parent or stepparent
with whom the child resides; or a noncustodial parent under order of a court or family
support magistrate to provide health insurance, who applies for coverage under the
HUSKY Plan, Part B on behalf of a child and shall include a child who is eighteen years
of age or emancipated in accordance with the provisions of sections 46b-150 to 46b-150e, inclusive, and who is applying on his own behalf or on behalf of a minor dependent
for coverage under such plan;
(2) "Child" means an individual under nineteen years of age;
(3) "Coinsurance" means the sharing of health care expenses by the insured and an
insurer in a specified ratio;
(4) "Commissioner" means the Commissioner of Social Services;
(5) "Copayment" means a payment made on behalf of an enrollee for a specified
service under the HUSKY Plan, Part B;
(6) "Cost sharing" means arrangements made on behalf of an enrollee whereby an
applicant pays a portion of the cost of health services, sharing costs with the state and
includes copayments, premiums, deductibles and coinsurance;
(7) "Deductible" means the amount of out-of-pocket expenses that would be paid
for health services on behalf of an enrollee before becoming payable by the insurer;
(8) "Department" means the Department of Social Services;
(9) "Durable medical equipment" means durable medical equipment, as defined in
Section 1395x(n) of the Social Security Act;
(10) "Eligible beneficiary" means a child who meets the requirements specified in
section 17b-292, except a child excluded under the provisions of Subtitle J of Public
Law 105-33 or a child of any municipal employee eligible for employer-sponsored
insurance on or after October 30, 1997, provided a child of such a municipal employee
may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage
was terminated due to an extreme economic hardship on the part of the employee, as
determined by the commissioner;
(11) "Enrollee" means an eligible beneficiary who receives services from a managed care plan under the HUSKY Plan, Part B;
(12) "Family" means any combination of the following: (A) An individual; (B) the
individual's spouse; (C) any child of the individual or such spouse; or (D) the legal
guardian of any such child if the guardian resides with the child;
(13) "HUSKY Plan, Part A" means assistance provided to children, caretaker relatives and pregnant women pursuant to section 17b-261 or 17b-277;
(14) "HUSKY Plan, Part B" means the health insurance plan for children established
pursuant to the provisions of sections 17b-289 to 17b-303, inclusive, and section 16 of
public act 97-1 of the October 29 special session*;
(15) "HUSKY Plus programs" means two supplemental health insurance programs
established pursuant to section 17b-294 for medically eligible enrollees of the HUSKY
Plan, Part B whose medical needs cannot be accommodated within the basic benefit
package offered to enrollees. One program shall supplement coverage for those medically eligible enrollees with intensive physical health needs and the other program shall
supplement coverage for those medically eligible enrollees with intensive behavioral
health needs;
(16) "Income" means income as calculated in the same manner as under the Medicaid program pursuant to section 17b-261;
(17) "Managed care plan" means a plan offered by an entity that contracts with the
department to provide benefits to enrollees on a prepaid basis;
(18) "Parent" means a natural parent, stepparent, adoptive parent, guardian or custodian of a child;
(19) "Premium" means any required payment made by an individual to offset or
pay in full the capitation rate under the HUSKY Plan, Part B;
(20) "Preventive care and services" means: (A) Child preventive care, including
periodic and interperiodic well-child visits, routine immunizations, health screenings
and routine laboratory tests; (B) prenatal care, including care of all complications of
pregnancy; (C) care of newborn infants, including attendance at high-risk deliveries and
normal newborn care; (D) WIC evaluations; (E) child abuse assessment required under
sections 17a-106a and 46b-129a; (F) preventive dental care for children; and (G) periodicity schedules and reporting based on the standards specified by the American Academy
of Pediatrics;
(21) "Primary and preventive health care services" means the services of licensed
physicians, optometrists, nurses, nurse practitioners, midwives and other related health
care professionals which are provided on an outpatient basis, including routine well-child visits, diagnosis and treatment of illness and injury, laboratory tests, diagnostic
x-rays, prescription drugs, radiation therapy, chemotherapy, hemodialysis, emergency
room services, and outpatient alcohol and substance abuse services, as defined by the
commissioner;
(22) "Qualified entity" means any entity: (A) Eligible for payments under a state
plan approved under Medicaid and which provides medical services under the HUSKY
Plan, Part A, or (B) that is a qualified entity, as defined in 42 USC 1396r-1a, as amended
by Section 708 of Public Law 106-554 and that is determined by the commissioner to
be capable of making the determination of eligibility. The commissioner shall provide
qualified entities with such forms as are necessary for an application to be made on
behalf of a child under the HUSKY Plan, Part A and information on how to assist parents,
guardians and other persons in completing and filing such forms;
(23) "WIC" means the federal Special Supplemental Food Program for Women,
Infants and Children administered by the Department of Public Health pursuant to section 19a-59c.
(October 29 Sp. Sess. P.A. 97-1, S. 2, 23; P.A. 99-279, S. 18, 45; P.A. 00-196, S. 53; P.A. 01-137, S. 2, 9; June 30 Sp.
Sess. P.A. 03-3, S. 73; P.A. 05-44, S. 2.)
*Note: Section 16 of public act 97-1 of the October 29 special session is special in nature and therefore has not been
codified but remains in full force and effect according to its terms.
History: Oct. 29 Sp. Sess. P.A. 97-1 effective October 30, 1997; P.A. 99-279 amended Subdiv. (10) to provide that a
child of a municipal employee may be eligible for coverage under the HUSKY Plan, Part B if dependent coverage was
terminated due to an extreme economic hardship on the part of the employee, as determined by the commissioner, effective
July 1, 1999; P.A. 00-196 made technical changes in Subdivs. (21) and (22); P.A. 01-137 amended Subdiv. (22) to redefine
"qualified entity" by deleting language contained in the federal definition of term and adding reference to such federal
definition, effective July 1, 2001 (Revisor's note: In Subdiv. (22), the word "that" was inserted editorially by the Revisors
after "(B)" for proper form); June 30 Sp. Sess. P.A. 03-3 amended introductory language to add reference to Sec. 17b-261f, effective August 20, 2003; P.A. 05-44 amended Subdiv. (13) to redefine "HUSKY Plan, Part A" to include assistance
provided to caretaker relatives and pregnant women pursuant to Sec. 17b-261 or 17b-277, effective July 1, 2005 (Revisor's
note: An erroneous reference to Sec. 17b-261f was deleted editorially by the Revisors to correct a codification error).
See Sec. 17b-261e re HUSKY and Medicaid coverage for isolation care and emergency services provided by the state's
mobile field hospital.