Common use of Care Agency Clause in Contracts

Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the patient’s attending Physician. It must be licensed by the appropriate state agency. Hospice A Provider which provides care for terminally ill patients and their families, either directly or on a consulting basis with the patient’s Physician. It must be licensed by the appropriate state agency. Hospice Care Program A coordinated, interdisciplinary program designed to meet the special physical, psychological, spiritual and social needs of the terminally ill Member and his or her covered family members, by providing palliative and supportive medical, nursing and other services through at- home or Inpatient care. The Hospice must be licensed by the appropriate state agency and must be funded as a Hospice as defined by those laws. It must provide a program of treatment for at least two unrelated individuals who have been medically diagnosed as having no reasonable prospect of cure for their illnesses. Hospital An institution licensed by the appropriate state agency, which is primarily engaged in providing diagnostic and therapeutic facilities on an Inpatient basis for the surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of Physicians duly licensed to practice medicine, and which continuously provides 24-hour-a-day nursing services by registered graduate nurses physically present and on duty. “Hospital” does not mean other than incidentally: • An extended care facility; nursing home; place for rest; facility for care of the aged; • A custodial or domiciliary institution which has as its primary purpose the furnishing of food, shelter, training or non-medical personal services; or • An institution for exceptional or handicapped children. Identification Card The latest card given to You showing Your name, covered Dependents, Your ID numbers, the type of coverage You have the claim submission address, and phone numbers for Customer Service, Prior Authorizations and Pharmacy Help Line. Incapacitated Dependent A Dependent in which the subscriber or the subscriber’s spouse is the court-appointed legal guardian; and the dependent is mentally or physically incapable of earning a living as determined by the Georgia Department of Human Resources, and the dependent is chiefly dependent upon the Subscriber for support and maintenance, provided that the onset of such incapacity occurred before the dependent was 26. Ineligible Charges Charges for health care services that are not Covered Services because the services are not Medically Necessary or Prior Authorization was not obtained. Such charges are not eligible for payment. Ineligible Hospital A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member by such a Hospital are not eligible for payment. Ineligible Provider A Provider which does not meet the minimum requirements to become an In-Network Provider or does not otherwise meet the requirements to contract with Alliant. Services rendered to a Member by such a Provider are not eligible for payment. Infertile or Infertility The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. Injury Bodily harm from a non-occupational accident. In-Network Care Covered Services provided to Members by their Physician through In-Network Hospital and In-Network Providers. In-Network Hospital A Hospital which is a party to a written agreement with, and in a form approved by, Alliant to provide services to its Members. In-Network Provider A Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, who is in the managed network for this specific plan or other closely managed specialty network, or who has a participation contract with Us. Inpatient A Member who is admitted into a Hospital and receives lodging and food, as well as treatment.

Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the patient’s attending Physician. It must be licensed by the appropriate state agency. Hospice A Provider which provides care for terminally ill patients and their families, either directly or on a consulting basis with the patient’s Physician. It must be licensed by the appropriate state agency. Hospice Care Program A coordinated, interdisciplinary program designed to meet the special physical, psychological, spiritual and social needs of the terminally ill Member and his or her covered family members, by providing palliative and supportive medical, nursing and other services through at- home or Inpatient care. The Hospice must be licensed by the appropriate state agency and must be funded as a Hospice as defined by those lawslaw. It must provide a program of programof treatment for at least two unrelated individuals who have been medically diagnosed as having no reasonable prospect of cure for their illnesses. Hospital An institution licensed by the appropriate state agency, which is primarily engaged in providing diagnostic and therapeutic facilities on an Inpatient basis for the surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of Physicians duly licensed to practice medicine, and which continuously provides 24-hour-a-day nursing services by registered graduate nurses physically present and on duty. “Hospital.“Hospital” does not mean other than incidentally: • An extended care facility; nursing home; place for restxxxxxxx; facility for care of the aged; • A custodial or domiciliary institution which has as its primary purpose the furnishing of food, shelter, ,training or non-medical personal services; or • An institution for exceptional or handicapped children. Identification Card The latest card given to You showing Your name, covered Dependents, Your ID and SimpleCare Group numbers, the type thetype of coverage You have the claim submission address, and phone numbers for Customer Service, Prior Authorizations and Pharmacy Help Line. Incapacitated Dependent A Dependent in which the subscriber or the subscriber’s spouse is the court-appointed legal guardian; and the dependent is mentally or physically incapable of earning a living as determined by the Georgia Department of Human Resources, and the dependent is chiefly dependent upon the Subscriber for support and maintenance, provided that the onset of such incapacity occurred before the dependent was 26. Ineligible Charges Charges for health care services that are not Covered Services because the services are not Medically Necessary or Prior Authorization was not obtained. Such charges are not eligible for payment. Ineligible Hospital A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member by such a Hospital are not eligible for payment. Ineligible Provider A Provider which does not meet the minimum requirements to become an In-Network Provider or does not otherwise meet the requirements to contract with Alliant. Services rendered to a Member by such a Provider are not eligible for payment. Infertile or Infertility The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. Initial Enrollees A person actively employed by the Group (or one of that person’s eligible Dependents, if applicable) on the original Effective Date of the group health plans coverage between Alliant and the Group or currently enrolled through the Group under an Alliant Contract. Injury Bodily harm from a non-occupational accident. In-Network Care Covered Services provided to Members by their Physician through In-Network Hospital and In-Network Providers. In-Network Hospital A Hospital which is a party to a written agreement with, and in a form approved by, Alliant to provide services to its Members. In-Network Provider A Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, who is in the managed network for this specific plan or other closely managed specialty network, or who has a participation contract with Uswithus. Inpatient A Member who is admitted into a Hospital and receives lodging and food, as well as treatment.

Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required ofrequired intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing inwriting by the patient’s attending Physician. It must be licensed by the appropriate state agency. Hospice A Provider which provides care for terminally ill patients and patientsand their families, either directly or on a consulting basis with basiswith the patient’s Physician. It must be licensed by the appropriate state agency. Hospice Care Program A coordinated, interdisciplinary program designed to meet the meetthe special physical, psychological, spiritual and social needs of the terminally ill Member and his or her covered family members, by providing palliative and supportive medical, nursing and other services through at- home or Inpatient care. The Hospice must be licensed by the appropriate state agency and must be funded as a Hospice as Hospiceas defined by those laws. It must provide a program of treatment for at least two unrelated individuals who have been medically diagnosed as having no reasonable prospect reasonableprospect of cure for their illnesses. Hospital An institution licensed by the appropriate state agency, which is primarily engaged in providing diagnostic and therapeutic facilities on an Inpatient basis for the surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of Physicians duly licensed to practice medicine, and which continuously provides 24-hour-a-day nursing services by registered graduate nurses physically present and on duty. “Hospital.“Hospital” does not mean other than incidentally: • An extended care facility; nursing home; place for restxxxxxxx; facility for care of the aged; • A custodial or domiciliary institution which has as its primary itsprimary purpose the furnishing of food, shelter, ,training or non-medical personal services; or • An institution for exceptional or handicapped childrenhandicappedchildren. Identification Card The latest card given to You showing Your name, covered Dependents, Your ID numbers, the type of coverage You have the claim submission address, and phone numbers for Customer Service, Prior Authorizations and Pharmacy Help Line. Incapacitated Dependent A Dependent in which the subscriber or the subscriber’s spouse is the court-appointed legal guardian; and the dependent is mentally or physically incapable of earning a living as determined by the Georgia Department of Human Resources, and the dependent is chiefly dependent upon the Subscriber for support and maintenance, provided that the onset of such incapacity occurred before the dependent was dependentwas 26. Ineligible Charges Charges for health care services that are not Covered Services because the services are not Medically Necessary or Necessaryor Prior Authorization was not obtained. Such charges are not eligible for payment. Ineligible Hospital A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member aMember by such a Hospital are not eligible for payment. Ineligible Provider A Provider which does not meet the minimum requirements to become an In-Network Provider or does not doesnot otherwise meet the requirements to contract with Alliant. Services rendered to a Member by such a Provider are not eligible for payment. Infertile or Infertility The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. Injury Bodily harm from a non-occupational accident. In-Network Care Covered Services provided to Members by their Physician through Physicianthrough In-Network Hospital and In-In- Network Providers. In-Network Hospital A Hospital which is a party to a written agreement with, and in a form approved by, Alliant to provide services to its MembersitsMembers. In-Network Provider A Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, who is in the managed network for this specific plan or other closely managed specialty network, or who has a participation contract with UswithUs. Inpatient A Member who is admitted into a Hospital and receives lodging and food, as well as treatment.

Care Agency. A Provider which renders care through a program for the treatment of a patient in the patient’s home, consisting of required intermittent skilled care, which may include observation, evaluation, teaching and nursing services consistent with the diagnosis, established and approved in writing by the patient’s attending Physician. It must be licensed by the appropriate state agency. Hospice Hospice‌ A Provider which provides care for terminally ill patients and their families, either directly or on a consulting basis with the patient’s Physician. It must be licensed by the appropriate state agency. Hospice Care Program Program‌ A coordinated, interdisciplinary program designed to meet the special physical, psychological, spiritual and social needs of the terminally ill Member and his or her covered family members, by providing palliative and supportive medical, nursing and other services through at- at-home or Inpatient care. The Hospice must be licensed by the appropriate state agency and must be funded as a Hospice as defined by those laws. It must provide a program of treatment for at least two unrelated individuals who have been medically diagnosed as having no reasonable prospect of cure for their illnesses. Hospital Hospital‌ An institution licensed by the appropriate state agency, which is primarily engaged in providing diagnostic and therapeutic facilities on an Inpatient basis for the surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of Physicians duly licensed to practice medicine, and which continuously provides 24-hour-a-day nursing services by registered graduate nurses physically present and on duty. “Hospital” does not mean other than incidentally: • An extended care facility; nursing home; place for rest; facility for care of the aged; • A custodial or domiciliary institution which has as its primary purpose the furnishing of food, shelter, training or non-medical personal services; or • An institution for exceptional or handicapped children. Identification Card Card‌ The latest card given to You you showing Your name, covered Dependents, Your ID your Member and Group numbers, the type of coverage You you have the claim submission address, and phone numbers for Customer Service, Prior Authorizations and Pharmacy Help Line. Incapacitated Dependent A Dependent in which the subscriber or the subscriber’s spouse is the court-appointed legal guardian; and the dependent is mentally or physically incapable of earning a living as determined by the Georgia Department of Human Resources, and the dependent is chiefly dependent upon the Subscriber for support and maintenance, provided that the onset of such incapacity occurred before the dependent was 26date coverage became effective. Ineligible Charges Charges‌ Charges for health care services that are not Covered Services because the services are not Medically Necessary or Prior Authorization Pre-Admission Certification was not obtained. Such charges are not eligible for payment. Ineligible Hospital Hospital‌ A facility which does not meet the minimum requirements to become an In-Network Hospital. Services rendered to a Member by such a Hospital are not eligible for payment. Ineligible Provider Provider‌ A Provider which does not meet the minimum requirements to become an In-Network Provider or with whom Alliant does not otherwise meet the requirements to contract with Alliantdirectly contract. Services rendered to a Member by such a Provider are not eligible for payment. Infertile or Infertility Infertility‌ The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of one year of frequent, unprotected heterosexual vaginal intercourse. This does not include conditions for men when the cause is a vasectomy or orchiectomy or for women when the cause is tubal ligation or hysterectomy. Injury Initial Enrollee‌ A person actively employed by the Group (or one of that person’s eligible Dependents) on the original Effective Date of the group health plans coverage between Alliant and the Group or currently enrolled through the Group under an Alliant Contract. Injury‌ Bodily harm from a non-occupational accident. In-Network Care Care‌ Covered Services provided to Members by their Physician through In-Network Hospital and In-Network Providers. In-Network Hospital A Hospital which is a party to a written agreement with, and in a form approved by, Alliant to provide services to its Members. In-Network Provider A Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, who is in the managed network for this specific plan or other closely managed specialty network, or who has a participation contract with Us. Inpatient A Member who is admitted into a Hospital has direct access to primary and receives lodging and food, as well as treatmentspecialty care directly from any In- Network Physician.