Copayment, if applicable, must be paid in addition to any other Copayments, Cash Deductible, and Coinsurance. COSMETIC SURGERY OR PROCEDURE. Any surgery or procedure which involves physical appearance, but which does not correct or materially improve a physiological function and is not Medically Necessary and Appropriate. COVERED CHARGES. Allowed Charges for the types of services and supplies described in the Covered Charges and Covered Charges with Special Limitations section of this Contract, as applicable to [Non-Network] benefits. The services and supplies must be: furnished or ordered by a health care Provider; and Medically Necessary and Appropriate to diagnose or treat an Illness or Injury. A Covered Charge is incurred on the date the service or supply is furnished. Subject to all of the terms of this Contract, We pay benefits for Covered Charges incurred by a [Member] while he or she is covered by this Contract. Read the entire Contract to find out what We limit or exclude. COVERED EMPLOYEE. A person who meets all applicable eligibility requirements, enrolls hereunder by making application, and for whom premium has been received. COVERED SERVICES OR SUPPLIES. The types of services and supplies described in the Covered Services and Supplies section of this Contract, as applicable to [Network] benefits. Read the entire Contract to find out what We limit or exclude. CURRENT PROCEDURAL TERMINOLOGY (C.P.T.) The most recent edition of an annually revised listing published by the American Medical Association which assigns numerical codes to procedures and categories of medical care. CUSTODIAL CARE. Any service or supply, including room and board, which: is furnished mainly to help a [Member] meet a [Member's] routine daily needs; or can be furnished by someone who has no professional health care training or skills. Even if a [Member] is in a Hospital or other Facility, We do not provide for that part of the care which is mainly custodial. [DEPENDENT. An Employee's: legal spouse which shall include a civil union partner pursuant to P.L. 2006, c. 103 as well as same sex relationships legally recognized in other jurisdictions when such relationships provide substantially all of the rights and benefits of marriage. [and domestic partner pursuant to P.L. 2003, c. 246]; except that legal spouse shall be limited to spouses of a marriage as marriage is defined in Federal law with respect to:
Copayment, if applicable, must be paid in addition to any other Copayments, Cash Deductible, and Coinsurance. COSMETIC SURGERY OR PROCEDURE. Any surgery or procedure which involves physical appearance, but which does not correct or materially improve a physiological function and is not Medically Necessary and Appropriate. COVERED CHARGES. Allowed Charges for the types of services and supplies described in the Covered Charges and Covered Charges with Special Limitations section of this Contract, as applicable to [Non-Network] benefits. The services and supplies must be: furnished or ordered by a health care Provider; and Medically Necessary and Appropriate to diagnose or treat an Illness or Injury. A Covered Charge is incurred on the date the service or supply is furnished. Subject to all of the terms of this Contract, We pay benefits for Covered Charges incurred by a [Member] while he or she is covered by this Contract. Read the entire Contract to find out what We limit or exclude. COVERED EMPLOYEE. A person who meets all applicable eligibility requirements, enrolls hereunder by making application, and for whom premium has been received. COVERED SERVICES OR SUPPLIES. The types of services and supplies described in the Covered Services and Supplies section of this Contract, as applicable to [Network] benefits. Read the entire Contract to find out what We limit or exclude. CURRENT PROCEDURAL TERMINOLOGY (C.P.T.) The most recent edition of an annually revised listing published by the American Medical Association which assigns numerical codes to procedures and categories of medical care. CUSTODIAL CARE. Any service or supply, including room and board, which: is furnished mainly to help a [Member] meet a [Member's] routine daily needs; or can be furnished by someone who has no professional health care training or skills. Even if a [Member] is in a Hospital or other Facility, We do not provide for that part of the care which is mainly custodial. [DEPENDENT. An Employee's: legal spouse which shall include a civil union partner pursuant to P.L. 2006, c. 103 as well as same sex relationships legally recognized in other jurisdictions when such relationships provide substantially all of the rights and benefits of marriage. [and domestic partner pursuant to P.L. 2003, c. 246]; except that legal spouse shall be limited to spouses of a marriage as marriage is defined in Federal law with respect to:
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