Page 84 - QCS.19 SPD - PPO

Chemically Equivalent - when Prescription Drug Products contain the same active ingredient.
Chiropractic Treatment (adjustments) – a form of care provided by chiropractors and osteopaths for diagnosed
muscle, nerve and joint problems. Body parts are moved either by hands or by a small instrument to:

· Restore or improve motion.
· Reduce pain.

· Increase function.
Claim Determination Period - a period of time during which you are covered by the plan.

Claims Administrator - United HealthCare Services, Inc. and its affiliates or subcontractors, who provide certain
claim administration services for the Plan

Coinsurance - the percentage of Allowed Amounts you are required to pay for Covered Health Care Services as
described in Section 3, How the Plan Works.
Company - QUEEN CITY SKILLED CARE LLC

Congenital Anomaly - a physical developmental defect that is present at the time of birth, and that is identified
within the first twelve months of birth.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) - a federal law that requires employers to
offer continued health insurance coverage to certain employees and their dependents whose group health
insurance has been terminated.

Continuous Creditable Coverage - health care coverage under any of the types of plans listed below, during
which there was no break in coverage of 63 consecutive days or more:
· a group health plan;

· health insurance coverage;
· Medicare;

· Medicaid;
· medical and dental care for members and certain former members of the uniformed services, and for their
dependents;
· a medical care program of the Indian Health Care Services Program or a tribal organization;

· a state health benefits risk pool;
· the Federal Employees Health Benefits Program;

· the State Children's Health Insurance Program (S-CHIP);
· health plans established and maintained by foreign governments or political subdivisions and by the U.S.
government;

· any public health benefit program provided by a state, county, or other political subdivision of a state; and
· a health benefit plan under the Peace Corps Act.

A waiting period for health care coverage will be included in the period of time counted as Continuous Creditable
Coverage.

Copayment - the charge, stated as a set dollar amount, that you are required to pay for certain Covered Health
Care Services.
NOTE: For Covered Health Care Services, you are responsible for paying the lesser of the following:

· The Copayment; or
· The Allowed Amount.

Page 79 Section 15 - Glossary
PPO - 2017