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In the predominant opinion among experts: As expressed in the published, authoritative literature, is substantially confined to use in research setting; or Is subject to further research in order to define safety, toxicity, effectiveness, or effectiveness compared with conventional alternatives; or Is experimental, investigational, unproven, or is not a generally acceptable medical practice; or Is not a covered service under Medicare because it is considered investigational or experimental as determined by the Centers for Medicare and Medicaid (CMS) of HHS; or Is provided concomitantly to a treatment, procedure, device or drug which is experimental, investigational, or unproven treatment.

The Plan may, in its discretion, determine that a drug, device, medical treatment, or procedure which is deemed experimental or investigational under the above criteria, should nonetheless not be deemed experimental or investigational.

Legacy Employee: An employee who is an active employee as of January 1, 2006, or an employee hired on or after January 1, 2006, who has ever been a full-time employee with a Mississippi State agency, public school district, community/junior college, public library, or university.

Legal Custody: the permanent legal status created by a court order which gives the legal custodian the responsibilities of physical possession of the child and the duty to provide him with food, shelter, education, and reasonable medical care.

Legal Custodian: a court appointed custodian of a child.

Legal Guardian: a court appointed guardian of a child.

Legal Guardianship: the permanent legal status created by a court order which gives the guardian of a child the same responsibilities as though he was the child’s natural parent. This includes the duty to feed, clothe, and house the child, and to make decisions concerning the child’s education and health care.

Lifetime Maximum: the maximum benefit payable under the Plan for any covered participant during his lifetime while covered under this Plan.

Maintenance Drug: a prescription drug taken for an extended period of time for a chronic health condition.

Manipulative Therapy: all services preparatory to or complementary to an adjustment of the articulations of the vertebral column and its immediate articulations.

Medical Management Administrator: the organization under contract with the State and School Employees Health Insurance Management Board to provide inpatient and outpatient utilization review and case management services. The Medical Management Administrator for the Plan is Intracorp.


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