Common use of Policy Year Clause in Contracts

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 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. The attending Physician must order these services. These services must be ordered by the attending Physician and also require the technical skills of an RN or LPN. We determine which services are Private Duty Nursing Services. Private Duty Nursing Services that are determined by Us to be Custodial Care are not covered. 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 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 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. The attending Physician must order these services. These services must be ordered by the attending Physician and also require the technical skills of an RN or LPN. We determine which services are Private Duty Nursing Services. Private Duty Nursing Services that are determined by Us to be Custodial Care are not covered. 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 healthcare 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.