[PARTICIPATING MAIL ORDER PHARMACY. A licensed and registered pharmacy operated by [ABC] or with whom [ABC] has signed a pharmacy service agreement, that is: equipped to provide Prescription Drugs through the mail; or is a Participating Pharmacy that is willing to accept the same pharmacy agreement terms, conditions, price and services as exist in the Participating Mail Order Pharmacy agreement.] [PARTICIPATING PHARMACY. A licensed and registered pharmacy operated by Us or with whom We have signed a pharmacy services agreement.] PERIOD OF CONFINEMENT. Consecutive days of Inpatient services provided to an Inpatient, or successive Inpatient confinements due to the same or related causes, when discharge and re-admission to a Facility occurs within 90 days or less. We Determine if the cause(s) of the confinements are the same or related. PLAN SPONSOR. Has the meaning given that term under Title I, section 3 of Pub.L.93-406, the ERISA (29 U.S.C. § 1002(16)(B)). That is: the Small Employer in the case of an employee benefit plan established or maintained by a single employer; the employee organization in the case of a plan established or maintained by an employee organization; or in the case of a plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan. PLAN YEAR. The year that is designated as the plan year in the plan document of a Group Health Plan, except if the plan document does not designate a plan year or if there is no plan document, the Plan Year is a Calendar Year. PRACTITIONER. A medical practitioner who: is properly licensed or certified to provide medical care under the laws of the state where the practitioner practices; and provides medical services which are within the scope of the practitioner's license or certificate. For purposes of Applied Behavior Analysis as included in the Diagnosis and Treatment of Autism and Other Developmental Disabilities provision, Practitioner also means a person who is credentialed by the national Behavior Analyst Certification Board as either a Board Certified Behavior Analyst – Doctoral or as a Board Certified Behavior Analyst. PRE-APPROVAL or PRE-APPROVED. Our approval using paper or electronic means for specified services and supplies prior to the date the charges are incurred. We will reduce benefits by 50% with respect to charges for treatment, services and supplies
[PARTICIPATING MAIL ORDER PHARMACY. A licensed and registered pharmacy operated by [ABC] or with whom [ABC] has signed a pharmacy service agreement, that is: equipped to provide Prescription Drugs through the mail; or is a Participating Pharmacy that is willing to accept the same pharmacy agreement terms, conditions, price and services as exist in the Participating Mail Order Pharmacy agreement.] [PARTICIPATING PHARMACY. A licensed and registered pharmacy operated by Us or with whom We have signed a pharmacy services agreement.] PERIOD OF CONFINEMENT. Consecutive days of Inpatient services provided to an Inpatient, or successive Inpatient confinements due to the same or related causes, when discharge and re-admission to a Facility occurs within 90 days or less. We Determine if the cause(s) of the confinements are the same or related. PLAN SPONSOR. Has the meaning given that term under Title I, section 3 of Pub.L.93-406, the ERISA (29 U.S.C. § 1002(16)(B)). That is: the Small Employer in the case of an employee benefit plan established or maintained by a single employer; the employee organization in the case of a plan established or maintained by an employee organization; or in the case of a plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan. PLAN YEAR. The year that is designated as the plan year in the plan document of a Group Health Plan, except if the plan document does not designate a plan year or if there is no plan document, the Plan Year is a Calendar Year. PRACTITIONER. A medical practitioner who: is properly licensed or certified to provide medical care under the laws of the state where the practitioner practices; and provides medical services which are within the scope of the practitioner's license or certificate. For purposes of Applied Behavior Analysis as included in the Diagnosis and Treatment of Autism and Other Developmental Disabilities provision, Practitioner also means a person who is credentialed by the national Behavior Analyst Certification Board as either a Board Certified Behavior Analyst – Doctoral or as a Board Certified Behavior Analyst. PRE-APPROVAL or PRE-APPROVED. Our approval using paper or electronic means for specified services and supplies prior to the date the charges are incurred. We will reduce benefits by 50% with respect to charges for treatment, services and supplies