Page 88 - QCS.19 SPD - PPO

You should know that all products identified as a "generic" by the manufacturer, pharmacy or your Physician may
not be classified as a Generic by us.
Hearing Aid - an electronic amplifying device designed to bring sound more effectively into the ear. A Hearing
Aid consists of microphone, amplifier and receiver.
Hearing Impairment - a reduction in the ability to perceive sound which may range from slight to complete
deafness.

Home Health Agency - a program or organization authorized by law to provide health care services in the home.
Hospital - an institution that is operated as required by law and that meets both of the following:

· it is mainly engaged in providing inpatient Health Care Services, for the short term care and treatment of
injured or sick persons. Care is provided through medical, diagnostic and surgical facilities, by or under
the supervision of a staff of Physicians; and

· it has 24-hour nursing services.
A Hospital is not mainly a place for rest, Custodial Care or care of the aged and is not a nursing home,
convalescent home or similar institution.
Initial Enrollment Period - the first period of time at new business when Eligible Persons may enroll themselves
and their Dependents under the Policy. The initial enrollment period ends once the installation process is
complete and a policy number is generated for the group
Injury - damage to the body, including all related conditions and symptoms.

Inpatient Rehabilitation Facility - any of the following that provides inpatient rehabilitation health care services
(including physical therapy, occupational therapy and/or speech therapy) as authorized by law.
· a long term acute rehabilitation center,

· a hospital, or
· a special unit of a Hospital designated as an inpatient Rehabilitation Facility.

Inpatient Stay - a continuouse stay that follows formal admission to a Hospital, Skilled Nursing Facility or
Inpatient Rehabilitation Facility.

Intensive Behavioral Therapy (IBT) - outpatient behavioral/educational services that aim to reinforce adaptive
behaviors, reduce maladaptive behaviors and improve the mastery of functional age appropriate skills in people
with Autism Spectrum Disorders. Examples include Applied Behavioral Analysis (ABA), The Denver Model, and
Relationship Development Intervention (RDI).

Intensive Outpatient Treatment - a structured outpatient mental health or substance-related and addictive
disorders treatment program. The program may be freestanding or Hospital-based and provides services for at
least three hours per day, two or more days per week.

Intermittent Care - skilled nursing care that is provided or needed either:
· fewer than seven days each week; or

· fewer than eight hours each day for periods of 21 days or less.
Exceptions may be made in certain circumstances when the need for more care is finite and predictable.

Late Enrollee - an Eligible Person or Dependent who enrolls for coverage under the Plan at a time other than the
following:

· during the Initial Enrollment Period;
· during an Open Enrollment Period;

· during a special enrollment period as described in Section 2, Introduction; or
· within 31 days of the date a new Eligible Person first becomes eligible.

Page 83 Section 15 - Glossary
PPO - 2017