2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 77
DEFINITIONS
In this section you will find the definitions for the capitalized words found throughout this Medical Plan. There may
be additional words or terms that have a meaning that pertains to a specific section and those definitions will be
found in that section provided, however, that any such capitalized word shall have such meaning when used in any
other section. These definitions are not an indication that charges for particular care, supplies or services are eligible
for payment under the Medical Plan. Please refer to the appropriate sections of this Medical Plan for that
information.
Affiliated Companies means any of the Medical Plan Sponsor's affiliates, subsidiaries, or divisions may be deleted
or added to the Medical Plan upon written notice on or before the date such deletion or addition is effective.
Ambulatory Surgical Center means a free-standing surgical center, which is not part of a Hospital and which: (1)
has an organized medical staff of Physicians; (2) has permanent facilities that are equipped and operated primarily
for the purpose of performing surgical procedures; (3) has continuous Physician’s services and registered graduate
nursing (R.N.) services whenever a patient is in the facility; (4) is licensed by the jurisdiction in which it is located;
and (5) does not provide for overnight accommodations.
Audiologist means a health care professional trained to evaluate, diagnose, and treat hearing loss and related
disorders, including balance (vestibular) disorders and tinnitus, and to rehabilitate people with hearing loss and
related disorders. An Audiologist must meet any state licensure requirements in the state in which they practice
and must be acting within the scope of their license.
Birthing Center means a place licensed as such by an agency of the state. If the state does not have any licensing
requirements, it must meet all of the following tests: (1) is primarily engaged in providing birthing services for low
risk pregnancies; (2) is operated under the supervision of a Physician; (3) has at least one registered nurse (R.N.)
certified as a nurse midwife in attendance at all times; (4) has a written agreement with a licensed ambulance for
that service to provide immediate transportation of the Covered Person to a Hospital as defined herein if an
emergency arises; and (5) has a written agreement with a Hospital located in the immediate geographical area of
the Birthing Center to provide emergency admission of the Covered Person.
Calendar Year means January 1 – December 31.
Close Relative means a Covered Person's Spouse, parent (including step-parents), sibling, child, grandparent or
in-law.
Coinsurance has the same meaning as set forth in the section of this Medical Plan entitled “General Overview of
the Medical Plan”.
Concurrent Care means ongoing care or course of treatment.
Concurrent Review means the Medical Management and Precertification Program Administrator will review all
inpatient admissions for a patient’s length of stay. The review is based on clinical information received by the
Medical Management and Precertification Program Administrator from the provider or facility.
Claims Administrator means the organization providing services to the Employer in connection with the operation
of this Medical Plan and performing such other functions, including processing of claims, as may be delegated to
it.
Copay has the same meaning as set forth in the section of this Medical Plan entitled “General Overview of the
Medical Plan”.
Cosmetic means any procedure which is primarily directed at improving an individual's appearance and does not
meaningfully promote the proper function of the body or prevent or treat Illness or disease.
Covered Employee means an eligible Employee whose coverage has become effective and has not been
terminated.
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