Common use of Application for Enrollment Clause in Contracts

Application for Enrollment. The original and any subsequent forms completed and signed by the Subscriber seeking coverage. Such Application may take the form of an electronic submission. Autism means a developmental neurological disorder, usually appearing in the first three years of life, which affects normal brain functions and is manifested by compulsive, ritualistic behavior and severely impaired social interaction and communication skills. This Contract shall provide benefits for the diagnosis of autism in accordance with the conditions, schedule of benefits, limitations as to type and scope of treatment authorized for neurological disorders, exclusions, cost-sharing arrangements and copayment requirements which exist in this contract for neurological disorders. This contract provides for habilitative or rehabilitative services (including applied behavior analysis) and other counseling or therapy services necessary to develop, maintain, and restore the functioning of an individual with ASD who is six years of age or under. There is an annual cap of $30,000 on claims paid for applied behavior analysis for the purpose of treating a person with ASD when applying the benefits required by Georgia House Bill 429. This cap only applies to applied behavior analysis and does not apply to the other treatments (such as counseling or therapy services) which may be required by HB 429. One year, January 1 – December 31 (also called year or calendar year). It does not begin before a Member’s Effective Date. It does not continue after a Member’s coverage ends. A drug item which is under patent by its original innovator or marketer. The patent protects the drug from competition from other drug companies. There are two types of Brand Name Drugs:  Single Source Brand: drugs that are produced by only one manufacturer and do not have a generic equivalent available.  Multi-Source Brand: drugs that are produced by multiple pharmaceutical manufacturers and do have a generic equivalent available on the market. A network of health care facilities selected for specific services based on criteria such as experience, outcomes, efficiency, and effectiveness. For example, an organ transplant managed care program wherein Members access select types of benefits through a specific network of medical centers. The network of health care professionals that entered into Contracts with Alliant Health Plans to provide transplant or other designated specialty services.