CIGNA High Deductible Health Plan (HDHP) - UCAR Finance ...

Employee
The term Employee means a full-time or part time employee
of the Employer who is currently in Active Service. The term
does not include employees who are temporary or who
normally work less than 8 hours a week for the Employer.
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Employer
The term Employer means the plan sponsor self-insuring the
benefits described in this booklet, on whose behalf CIGNA is
providing claim administration services.
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Essential Health Benefits
Essential health benefits means, to the extent covered under
the plan, expenses incurred with respect to covered services, in
at least the following categories: ambulatory patient services,
emergency services, hospitalization, maternity and newborn
care, mental health and substance use disorder services,
including behavioral health treatment, prescription drugs,
rehabilitative and habilitative services and devices, laboratory
services, preventive and wellness services and chronic disease
management and pediatric services, including oral and vision
care.
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Expense Incurred
An expense is incurred when the service or the supply for
which it is incurred is provided.
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Free-Standing Surgical Facility
The term Free-standing Surgical Facility means an institution
which meets all of the following requirements:
• it has a medical staff of Physicians, Nurses and licensed
anesthesiologists;
• it maintains at least two operating rooms and one recovery
room;
• it maintains diagnostic laboratory and x-ray facilities;
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• it has equipment for emergency care;
• it has a blood supply;
• it maintains medical records;
• it has agreements with Hospitals for immediate acceptance
of patients who need Hospital Confinement on an inpatient
basis; and
• it is licensed in accordance with the laws of the appropriate
legally authorized agency.
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Hospice Care Program
The term Hospice Care Program means:
• a coordinated, interdisciplinary program to meet the
physical, psychological, spiritual and social needs of dying
persons and their families;
• a program that provides palliative and supportive medical,
nursing and other health services through home or inpatient
care during the illness;
• a program for persons who have a Terminal Illness and for
the families of those persons.
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Hospice Care Services
The term Hospice Care Services means any services provided
by: a Hospital, a Skilled Nursing Facility or a similar
institution, a Home Health Care Agency, a Hospice Facility,
or any other licensed facility or agency under a Hospice Care
Program.
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Hospice Facility
The term Hospice Facility means an institution or part of it
which:
• primarily provides care for Terminally Ill patients;
• is accredited by the National Hospice Organization;
• meets standards established by CIGNA; and
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