Sec. 8. As used in this chapter, “urgent care situation” means a situation in which a covered individual‘s treating physician has determined that the covered individual’s condition is likely to result in:

(1) adverse health consequences or serious jeopardy to the covered individual’s life, health, or safety; or

Terms Used In Indiana Code 27-1-37.5-8

  • covered individual: means an individual who is covered under a health plan. See Indiana Code 27-1-37.5-2
  • prior authorization: means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. See Indiana Code 27-1-37.5-7
(2) due to the covered individual’s psychological state, serious jeopardy to the life, health, or safety of another individual;

unless treatment of the covered individual’s condition for which prior authorization is sought occurs earlier than the period generally considered by the medical profession to be reasonable to treat routine or non-life threatening conditions.

As added by P.L.77-2018, SEC.2.

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