These definitions may be referenced in your Summary Plan Document (SPD). We believe our usage of these terms is unambiguous and have decided to define them here in order to make the Plan Document more concise.
“Accident”
“Accident” shall mean an event which takes place without one’s foresight or expectation, or a deliberate act that results in unforeseen consequences.
“Calendar Year”
“Calendar Year” shall mean the 12 month period from January 1 through December 31 of each year.
“Certified IDR Entity”
“Certified IDR Entity” shall mean an entity responsible for conducting determinations under the No Surprises Act and that has been properly certified by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury.
“Dentist”
“Dentist” shall mean a properly trained person holding a D.D.S. or D.M.D. degree and practicing within the scope of a license to practice dentistry within their applicable geographic venue.
“Diagnosis”
“Diagnosis” shall mean the act or process of identifying or determining the nature and cause of an Illness or Injury through evaluation of patient history, examination, and review of laboratory data. Diagnosis shall also mean the findings resulting from such act or process.
“Health Savings Account (HSA)”
“Health Savings Account (HSA)” shall mean an account created in connection with a High Deductible Health Plan. The money placed in this account can be used to pay for covered health care costs or saved for future health care costs. The account accrues interest.
“High Deductible Health Plan (HDHP)”
“High Deductible Health Plan” shall mean a health plan which has to meet specific federal rules. Participants in a High Deductible Health Plan may be able to put money into a Health Savings Account or health reimbursement arrangement to help pay for health care. The plan Deductible applicable for such plans is generally higher than that of a standard health plan.
“Pregnancy”
“Pregnancy” shall mean a physical state whereby a woman presently bears a child or children in the womb, prior to but likely to result in childbirth, miscarriage and/or non-elective abortion. Pregnancy is considered an Illness for the purpose of determining benefits.
“Nurse”
“Nurse” shall mean an individual who has received specialized nursing training and is authorized to use the designation Registered Nurse (R.N.), Licensed Vocational Nurse (L.V.N.) or Licensed Practical Nurse (L.P.N.), and who is duly licensed by the State or regulatory agency responsible for such license in the State in which the individual performs the nursing services.
“Uniformed Services”
“Uniformed Services” shall mean the Armed Forces, the Army National Guard and the Air National Guard, when engaged in active duty for training, inactive duty training, or full-time National Guard duty, the commissioned corps of the Public Health Service, and any other category of persons designated by the President of the United States in time of war or Emergency.