114 A Provider licensed when required by law and approved by us, that: 1. Gives skilled nursing and other services on a visiting basis in your home; and 2. Supervises the delivery of services under a plan prescribed and approved in writing by the attending Doctor. Hospice A Provider that gives care to terminally ill patients and their families, either directly or on a consulting basis with the patient’s Doctor. It must be licensed by the appropriate agency. Hospital A facility licensed as a Hospital as required by law that must satisfy our accreditation requirements and be approved by us. The term Hospital does not include a Provider, or that part of a Provider, used mainly for: 1. Nursing care 2. Rest care 3. Convalescent care 4. Care of the aged 5. Custodial Care 6. Educational care 7. Subacute care Identification Card (ID Card) The card given to you that showing your Member identification, group numbers, and the plan you have. Inpatient A Member who is treated as a registered bed patient in a Hospital and for whom a room and board charge is made. Intensive In-Home Behavioral Health Program A range of therapy services provided in the home to address symptoms and behaviors that, as the result of a Mental Disorder or Substance Use Disorder, put the Members and others at risk of harm. Intensive Outpatient Program Short-term behavioral health treatment that provides a combination of individual, group and family therapy. Late Enrollees Subscribers or Dependents who enroll in the Plan after the initial enrollment period. A person will not be considered a Late Enrollee if he or she enrolls during a Special Enrollment period. Please see the “Please refer to the “Prescription Drug List” and “Step Therapy Protocol Exceptions” sections in “Prescription Drug Benefit at a Home Delivery (Mail Order) Pharmacy” for the process to submit an exception request for Drugs not on the Prescription Drug List or that require Step Therapy.

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