The term Hospital specifically refers to a short-term, acute care, general Hospital which has been approved by The Joint Commission on Accreditation of Healthcare Organizations; and/or by the American Osteopathic Hospital Association or by the Claims Administrator, and which meets the following requirements: Is a duly licensed institution; Is primarily engaged in providing Inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick persons by or under the supervision of Physicians; Has organized departments of medicine; Provides 24-hour nursing service by or under the supervision of Registered Nurses; Is not, than incidentally, any of the following: Skilled Nursing Facility; Place for treatment of Mental Nursing home; Illness; School; Place for treatment of Alcohol or Drug Custodial Care home; Abuse; Health resort; Place for provision of rehabilitation care; Spa or sanitarium; for treatment of pulmonary Place for rest; tuberculosis; Place for aged; Place for provision of Hospice care. Hospital-Based Provider A Physician who provides Medically Necessary services in a Hospital or other In-Network Facility Provider and meets the requirements listed below: The Medically Necessary services must be supplemental to the primary care being provided in the Hospital or In-Network Facility Provider; The Medically Necessary services must be those for which the Member has limited or no control of the selection of such Physician; Hospital-Based Providers include Physicians in the specialties of: Radiology; Anesthesiology; Pathology; and/or Other specialties, as determined by the Claims Administrator. When Physicians provide services other than in the Hospital or other In-Network Facility, they are not considered Hospital-Based Providers. Identification Card (ID Card) The currently effective card issued to the Member by the Claims Administrator which must be presented when a Covered Service is requested. Immediate Family The Employee's: Spouse; Mother-in-law, father-in-law; Parent; Sister-in-law, brother-in-law; Child, stepchild; Daughter-in-law, son-in-law. Brother, sister;
The term Hospital specifically refers to a short-term, acute care, general Hospital which has been approved by The Joint Commission on Accreditation of Healthcare Organizations; and/or by the American Osteopathic Hospital Association or by the Claims Administrator, and which meets the following requirements: Is a duly licensed institution; Is primarily engaged in providing Inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick persons by or under the supervision of Physicians; Has organized departments of medicine; Provides 24-hour nursing service by or under the supervision of Registered Nurses; Is not, than incidentally, any of the following: Skilled Nursing Facility; Place for treatment of Mental Nursing home; Illness; School; Place for treatment of Alcohol or Drug Custodial Care home; Abuse; Health resort; Place for provision of rehabilitation care; Spa or sanitarium; for treatment of pulmonary Place for rest; tuberculosis; Place for aged; Place for provision of Hospice care. Hospital-Based Provider A Physician who provides Medically Necessary services in a Hospital or other In-Network Facility Provider and meets the requirements listed below: The Medically Necessary services must be supplemental to the primary care being provided in the Hospital or In-Network Facility Provider; The Medically Necessary services must be those for which the Member has limited or no control of the selection of such Physician; Hospital-Based Providers include Physicians in the specialties of: Radiology; Anesthesiology; Pathology; and/or Other specialties, as determined by the Claims Administrator. When Physicians provide services other than in the Hospital or other In-Network Facility, they are not considered Hospital-Based Providers. Identification Card (ID Card) The currently effective card issued to the Member by the Claims Administrator which must be presented when a Covered Service is requested. Immediate Family The Employee's: Spouse; Mother-in-law, father-in-law; Parent; Sister-in-law, brother-in-law; Child, stepchild; Daughter-in-law, son-in-law. Brother, sister;
ST-9.docx