When the Rialto Health Plan Determines Which of the Emergency

question 126

Multiple Choice

When the Rialto Health Plan determines which of the emergency services received by its plan members should be covered by the health plan, it is guided by a standard which describes emergencies as medical conditions manifesting themselves by acute symptoms of sufficient severity (including severe pain) such that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy. This standard, which was adopted by the NAIC in 1996, is referred to as the

• A) medical necessity standard
• B) prudent layperson standard
• C) "all-or-none" standard
• D) reasonable and customary standard

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Definitions:

Financial Status

Describes the current state of an individual's or organization's finances, encompassing aspects such as income, debts, assets, and liabilities.

Potential Suppliers

Companies or individuals who might be able to provide goods or services that an organization needs.

Buying Center

A group of people within an organization who are involved in the decision-making process for a purchase.

Deciders

Individuals or groups within an organization who have the authority to make final purchasing decisions.