Policy Year. The period of twelve
Policy Year. The 12-month period beginning with the Effective Date of this Contract or the anniversary of this date, and ending on the day before the next anniversary of the Effective Date. Prescription Drugs – Medications, including Specialty Drugs, for which legally selling or dispensing them requires an order from a Physician or other healthcare professional. These drugs carry the federally required product legend stating that they may not be dispensed without a prescription. The United States Food and Drug Administration currently approves prescription drugs for safety and effectiveness. Coverage for prescription drugs is subject to the details stated in Article 9: When Won’t the Plan Pay? Limitations and Exclusions. Private Duty Nursing Services – Services of an actively practicing Registered Nurse (RN) or Licensed Practical Nurse (LPN) who is unrelated to the patient by blood, marriage, or adoption. These services must be ordered by the attending Physician and require the technical skills of an RN or LPN. Prosthetic Appliance – Appliances which replace all or part of a body organ, or replace all or part of the function of a permanently inoperative, absent, or malfunctioning body part. Provider – A Hospital, Allied Health Facility, Physician, or Allied Health Professional that We approve, is licensed where required, and performs within the scope of that license. If a Provider does not have a state or federal license, We have the right to define all criteria under which the Provider may offer services to Our Members for Benefits to apply to a Provider’s Claims. If Providers who do not meet these criteria submit Claims, We will not pay them. Provider Incentive – An additional amount of compensation paid to a health care Provider by a payer, based on the Provider's compliance with agreed-upon procedural and/or outcome measures for a particular group or population of covered persons. Rehabilitative Care – Coordinated use of medical, social, educational, or vocational services ⎯ beyond the acute care stage of disease or injury ⎯ to upgrade the physical functional ability of a patient who is disabled by disease or injury so that the patient may independently carry out ordinary daily activities.
Policy Year. The period of twelve (12) consecutive months beginning on the effective date of the policy and any subsequent twelve month period thereafter.
Policy Year a one-year-period from the Effective Date or from the Anniversary Date.
Policy Year. This is the period of time from anniversary date to anniversary date except in the first year when it is the period of time from the effective date to the first anniversary date. Precertification, Precertify, Precertified A process where Aetna is contacted before certain services are provided, such as hospitalization or outpatient services, or prescription drugs are prescribed to determine whether the services being recommended or the drugs prescribed are considered covered medical expenses under the plan. It is not a guarantee that benefits will be payable if, for example, it is determined at the time the claim is submitted that the covered person was not eligible for benefits at that time. Preferred Care: This is care provided by • A covered person's primary care physician; or a preferred care provider on the referral of the primary care physician; or • A health care provider that is not a Preferred Care Provider for an emergency medical condition when travel to a Preferred Care Provider; or referral by a covered person’s primary care physician prior to treatment; is not feasible; or • A Non-Preferred Urgent Care Provider when travel to a Preferred Urgent Care Provider for treatment is not feasible; and if authorized by Aetna.
Policy Year. The 12-month period beginning with the Effective Date of this Contract or the anniversary of this date, and ending on the day before the next anniversary of the Effective Date.
Policy Year. A period of twelve (12) months commencing on the premium due date and each following period of equal duration. In the event of the period from the inception date of the insurance until the premium due date or from the premium due date until the date of termination being less than twelve (12) months, such a period shall also be deemed to be a policy year. In the event of the period of insurance being less than twelve (12) months, the policy year shall coincide with the period of insurance.
Policy Year. The 12-month period beginning with the Effective Date of this Contract or the anniversary of this date, and ending on the day before the next anniversary of the Effective Date. Pre-Existing Condition Admission ◼ A condition that would have caused an ordinary prudent person to seek medical advice, diagnosis, care, or treatment during the 365 days immediately before the Effective Date of this Contract; or ◼ A condition for which medical advice, diagnosis, care, treatment, or a prescribed drug was recommended or received during the 365 days immediately before the Effective Date; or ◼ A pregnancy existing on the Effective Date. We do not treat genetic information as a Pre-Existing Condition if no diagnosis of the condition related to that information existed.
Policy Year. Issue Age ULT All Age ---------------------------------------------------------------------------- F M 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Prem F M 18 19 20 21 22 18 23 19 24 20 25 21 26 22 27 23 28 24 29 25 30 26 31 27 32 28 33 29 34 30 35 31 36 32 37 33 [+ + + + + + + + + +] 38 34 39 35 40 36 41 37 42 38 43 39 44 40 45 41 46 42 47 43 48 44 49 45 50 46 51 47 52 48 53 49 54 50 [+ + + + + + + + + +] EXHIBIT C - CONTINUED WESTERN RESERVE - NON SMOKER Page 2 Age Nearest Birthday
Policy Year. The year commencing with the Policy Date and ending on the day before the first Policy Anniversary, or any following year commencing with a Policy Anniversary and ending on the day before the next Policy Anniversary.
