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

Question

Quizplus · Accepted Answer

The standard described is the prudent layperson standard, which was adopted by the NAIC in 1996. It defines 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.

When the Rialto Health Plan Determines Which of the Emergency