Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of 1 year of frequent, unprotected heterosexual sexual intercourse. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy.
Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination (for Members less than 35 years of age), or 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination (for Members 35 years of age or older). Infertile or Infertility does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy with or without surgical reversal. • Institute of ExcellenceTM (IOE). One of a network of facilities within the National Medical Excellence Program® specifically contracted with by HMO to provide certain Transplants to Members. A facility is considered a Participating Provider only for those types of Transplants for which it has been specifically contracted.
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 sexual intercourse. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Institute of ExcellenceTM (IOE). One of a network of facilities within the National Medical Excellence Program® specifically contracted with by HMO to provide certain Transplants to Members. A facility is considered a Participating Provider only for those types of Transplants for which it has been specifically contracted.
Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of 1 year of timed, unprotected coitus, or 12 cycles of artificial insemination (for Members less than 35 years of age), or 6 months or more of timed unprotected coitus, or 6 cycles of artificial insemination (for Members age 35 years of age or older). Infertile or Infertility does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Inquiry. A Member’s request for administrative service, information, or to express an opinion, including but not limited to, claims regarding scope of coverage for health services, denials, cancellations, terminations or renewals, and the quality of services provided. • Institute of ExcellenceTM (IOE). One of a network of facilities specifically contracted with by HMO to provide certain Transplants to Members. A facility is considered a Participating Provider only for those types of Transplants for which it has been specifically contracted. • Life-Threatening Or Seriously Debilitating Condition. A disease or condition (including the diagnosis of HIV or AIDS):
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 sexual intercourse. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Medical Community. A majority of Physicians who are Board Certified in the appropriate specialty. • Medical Emergency. Services to treat a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in:
Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination (for Members less than 35 years of age), or 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination (for Members 35 years of age or older). Infertile or Infertility does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy with or without surgical reversal.
Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination (for Members less than 35 years of age), or 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination (for Members 35 years of age or older). Infertile or Infertility does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy with or without surgical reversal. • Medical Community. A majority of Physicians who are Board Certified in the appropriate specialty. • Medical Emergency. The existence of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, could reasonably expect the absence of immediate medical attention to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman and her unborn child) in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ or part. • Medical Services. The professional services of Health Professionals, including medical, surgical, diagnostic, therapeutic, preventive care and birthing facility services. • Medically Necessary, Medically Necessary Services, or Medical Necessity. Services that are appropriate and consistent with the diagnosis in accordance with accepted medical standards as described in the Covered Benefits section of this Certificate. Medical Necessity, when used in relation to services, shall have the same meaning as Medically Necessary Services. This definition applies only to the determination by HMO of whether health care services are Covered Benefits under this Certificate. • Member(s). A Subscriber or Covered Dependent as defined in this Certificate. • Mental or Behavioral Condition. A condition which manifests signs and/or symptoms which are primarily mental or behavioral, for which the primary treatment is psychotherapy, psychotherapeutic methods or procedures, and/or the administration of psychotropic medication, regardless of any underlying physical or medical cause. Mental or behavioral disorders and conditions include, but are not limited to, psychosis, affective disorders, anxiety disorders, personality disorders, obsessive-compulsive disorders, attention disorders with or without hyperactivity, and o...
Infertile or Infertility. The condition of a presumably healthy Member who is unable to conceive or produce conception after a period of 1 year of frequent, unprotected heterosexual sexual intercourse. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Medical Emergency. The existence of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman and her unborn child) in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ or part. • Medical Services. The professional services of Health Professionals, including medical, surgical, diagnostic, therapeutic, preventive care and birthing facility services. • Medically Necessary, Medically Necessary Services, or Medical Necessity. Services that are appropriate and consistent with the diagnosis in accordance with accepted medical standards as described in the Covered Benefits section of this Certificate. Medical Necessity, when used in relation to services, shall have the same meaning as Medically Necessary Services. This definition applies only to the determination by HMO of whether health care services are Covered Benefits under this Certificate. • Member(s). A Subscriber or Covered Dependent as defined in this Certificate. • Mental or Behavioral Condition. A condition which manifests signs and/or symptoms which are primarily mental or behavioral, for which the primary treatment is psychotherapy, psychotherapeutic methods or procedures, and/or the administration of psychotropic medication, regardless of any underlying physical or medical cause. Mental or behavioral disorders and conditions include, but are not limited to, psychosis, affective disorders, anxiety disorders, personality disorders, obsessive-compulsive disorders, attention disorders with or without hyperactivity, and other psychological, emotional, nervous, behavioral, or stress-related abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems, whether or not caused by or in any way resulting from chemical imbalance, physical trauma, ...
Infertile or Infertility. The condition of a presumably healthy Member who is (a) unable to conceive or produce conception after a period of 1 year of frequent, unprotected heterosexual sexual intercourse, or (b) unable to sustain a successful pregnancy. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Medical Community. A majority of Physicians who are Board Certified in the appropriate specialty. • Medical Director or Designee. A Physician designated by HMO, who is responsible for the administration of HMO’s medical programs. The Medical Director may designate the Director of Medical Services to administer certain programs on his behalf. • Medical Emergency. The existence of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman and her unborn child) in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ or part. • Medical Services. The professional services of Health Professionals, including medical, surgical, diagnostic, therapeutic, preventive care and birthing facility services. • Medically Necessary, Medically Necessary Services, or Medical Necessity. Services that are appropriate and consistent with the diagnosis in accordance with accepted medical standards as described in the Covered Benefits section of this Certificate. Medical Necessity, when used in relation to services, shall have the same meaning as Medically Necessary Services. This definition applies only to the determination by HMO of whether health care services are Covered Benefits under this Certificate. • Member(s). A Subscriber or Covered Dependent as defined in this Certificate. • Mental or Behavioral Condition. A condition which manifests signs and/or symptoms which are primarily mental or behavioral, for which the primary treatment is psychotherapy, psychotherapeutic methods or procedures, and/or the administration of psychotropic medication, regardless of any underlying physical or medical cause. Mental or behavioral disorders and conditions include, but are not limited to, psychosis, affective disorders, anxi...
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 sexual intercourse. This does not include conditions for male Members when the cause is a vasectomy or orchiectomy or for female Members when the cause is a tubal ligation or hysterectomy. • Limited Provider Network. A subnetwork of HMO’s Providers in which contractual relationships exist between Physicians, Providers, independent physician associations, or physician groups that limits the Providers to which Members have access to those Providers in the subnetwork.
