Page 35 - Aegion PPO SPDs
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Service Area - The geographical area within which Covered Services under the Plan are available.
Single Coverage – Coverage for the Subscriber only.
Skilled Care - Care which is Medically Necessary and must be performed or supervised by a skilled
licensed professional in the observation and/or assessment of treatment of an illness or injury. It is ordered
by a Physician and usually involves a treatment plan.
Stabilize - The provision of medical treatment to You in an Emergency as may be necessary to assure,
within reasonable medical probability that material deterioration of Your condition is not likely to result from
or during any of the following:
Your discharge from an Emergency department or other care setting where Emergency Care is
provided to You;
Your transfer from an Emergency department or other care setting to another Facility; or
Your transfer from a Hospital Emergency department or other Hospital care setting to the Hospital’s
Inpatient setting.
Subcontractor - The Claims Administrator and/or Employer may subcontract particular services to
organizations or entities that have specialized expertise in certain areas. Such subcontracted organizations
or entities may make benefit determinations and/or perform administrative, claims paying, or Member
Services duties on the Claims Administrator's or Employer's behalf.
Subscriber - An eligible employee or former employee of the Employer enrolled under the Plan, whose
benefits are in effect and whose name appears on the Identification Card issued by the Claims
Administrator. Subscriber may also be a family member enrolled under COBRA separately from the
employee or former employee.
Therapy Services - Services and supplies used to promote recovery from an illness or injury. Covered
Therapy Services are limited to those services specifically listed in the Covered Services section.
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Single Coverage – Coverage for the Subscriber only.
Skilled Care - Care which is Medically Necessary and must be performed or supervised by a skilled
licensed professional in the observation and/or assessment of treatment of an illness or injury. It is ordered
by a Physician and usually involves a treatment plan.
Stabilize - The provision of medical treatment to You in an Emergency as may be necessary to assure,
within reasonable medical probability that material deterioration of Your condition is not likely to result from
or during any of the following:
Your discharge from an Emergency department or other care setting where Emergency Care is
provided to You;
Your transfer from an Emergency department or other care setting to another Facility; or
Your transfer from a Hospital Emergency department or other Hospital care setting to the Hospital’s
Inpatient setting.
Subcontractor - The Claims Administrator and/or Employer may subcontract particular services to
organizations or entities that have specialized expertise in certain areas. Such subcontracted organizations
or entities may make benefit determinations and/or perform administrative, claims paying, or Member
Services duties on the Claims Administrator's or Employer's behalf.
Subscriber - An eligible employee or former employee of the Employer enrolled under the Plan, whose
benefits are in effect and whose name appears on the Identification Card issued by the Claims
Administrator. Subscriber may also be a family member enrolled under COBRA separately from the
employee or former employee.
Therapy Services - Services and supplies used to promote recovery from an illness or injury. Covered
Therapy Services are limited to those services specifically listed in the Covered Services section.
35
