provide full-time Skilled Nursing Care by or under the supervision of Nurses; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. We will recognize it if: it carries out its stated purpose under all relevant state and local laws; or it is approved for its stated purpose by the Accreditation Association for Ambulatory Care; or it is approved for its stated purpose by Medicare. We do not recognize a Facility as a Birthing Center if it is part of a Hospital. Board means the Board of Directors of the New Jersey Individual Health Coverage Program, appointed and elected under the laws of . [Brand Name Drug means: a) a Prescription Drug as determined by the Food and Drug Administration; and b) protected by the trademark registration of the pharmaceutical company which produces them.] Calendar Year means each successive 12 month period which starts on January 1 and ends on December 31. Cash Deductible means the amount of Covered Charges that a Covered Person must pay before this Policy pays any benefits for such charges. Cash Deductible does not include Coinsurance, Copayments and Non-Covered Charges. Church Plan has the same meaning given that term under Title I, section 3 of Pub.L.93-406, the “Employee Retirement Income Security Act of 1974” Coinsurance means the percentage of a Covered Charge that must be paid by a Covered Person. Coinsurance does not include Cash Deductibles, Copayments or Non-Covered Charges. [Complex Imaging Services means any of the following services: Computed Tomography (CT), Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiogram (MRA), Magnetic Resonance Spectroscopy (MRS) Positron Emission Tomography (PET), Nuclear Medicine including Nuclear Cardiology.] Copayment means a specified dollar amount a Covered Person must pay for specified Covered Charges. Note: The Emergency Room Copayment, if applicable, must be paid in addition to the Cash Deductible, any other Copayments, and Coinsurance. Cosmetic Surgery or Procedure means 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.
provide full-time Skilled Nursing Care by or under the supervision of Nurses; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. We will recognize it if: it carries out its stated purpose under all relevant state and local laws; or it is approved for its stated purpose by the Accreditation Association for Ambulatory Care; or it is approved for its stated purpose by Medicare. We do not recognize a Facility as a Birthing Center if it is part of a Hospital. Board means the Board of Directors of the New Jersey Individual Health Coverage Program, appointed and elected under the laws of . [Brand Name Drug means: a) a Prescription Drug as determined by the Food and Drug Administration; and b) protected by the trademark registration of the pharmaceutical company which produces them.] Calendar Year means each successive 12 month period which starts on January 1 and ends on December 31. Cash Deductible means the amount of Covered Charges that a Covered Person must pay before this Policy pays any benefits for such charges. Cash Deductible does not include Coinsurance, Copayments and Non-Covered Charges. Church Plan has the same meaning given that term under Title I, section 3 of Pub.L.93-406, the “Employee Retirement Income Security Act of 1974” Coinsurance means the percentage of a Covered Charge that must be paid by a Covered Person. Coinsurance does not include Cash Deductibles, Copayments or Non-Covered Charges. [Complex Imaging Services means any of the following services: Computed Tomography (CT), Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiogram (MRA), Magnetic Resonance Spectroscopy (MRS) Positron Emission Tomography (PET), Nuclear Medicine including Nuclear Cardiology.] Copayment means a specified dollar amount a Covered Person must pay for specified Covered Charges. Note: The Emergency Room Copayment, if applicable, must be paid in addition to the Cash Deductible, any other Copayments, and Coinsurance. Cosmetic Surgery or Procedure means 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.
A50DPolicy2018P.docx