Accidental Injury: a sudden and unforeseen event from an external agent or trauma, resulting in injuries to the physical structure of the body. It is definite as to time and place and it happened involuntarily or, if the result of a voluntary act, entails unforeseen consequences.
Acute Care: short-term diagnostic and therapeutic services provided in a hospital for a patient who is ill from a disease or injury of an acute nature. The period of acute care continues until the patient is stable enough to be transferred to a long-term care facility or bed for rehabilitation or maintenance care or until the patient can be discharged to home care.
Allowable Charge: the lesser of the submitted charge or the amount established by the Plan as the maximum amount allowed for covered expenses.
Ambulatory Surgical Facility: an institution licensed as such by the appropriate state agency or certified by Medicare as an Ambulatory Surgical Facility whose primary purpose is performing elective or non-emergency surgical procedures on an outpatient basis and is approved by the Claims Administrator.
Brand Name Drug: A drug with a trademark name protected by a patent issued to the original innovator or marketer. The patent prohibits the manufacture of the drug by other companies without consent of the innovator, as long as the patent remains in effect.
Calendar Year: a twelve (12) month period beginning each January 1.
Certificate of Creditable Coverage: certificate provided by a prior health insurance carrier showing dates of creditable coverage as defined by HIPAA.
Certification: a review by Intracorp to determine if an admission or healthcare service is medically necessary as well as meets the notification requirements of the Plan.
Child: any natural child, stepchild, child placed in anticipation of adoption, legally adopted child, child for whom the enrollee is legal guardian, child for whom the enrollee has legal custody, or child of the enrollee who is required to be covered by reason of a Qualified Medical Child Support Order.
Claims Administrator: the organization under contract with the Health Insurance Management Board to maintain eligibility and process medical claims for the Plan. The claims administrator for the Plan is Blue Cross & Blue Shield of Mississippi.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986): Federal regulations that provide participants the option to pay for continued coverage under the Plan in the event that the participant no longer meets the Plan eligibility requirements.