116 • Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, • Doctor of Osteopathy (D.O.) legally licensed to perform the duties of a D.O., • Doctor of Chiropractic (D.C.), legally licensed to perform the duties of a chiropractor, • Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry, and • Doctor of Dental Medicine (D.D.M.), Doctor of Dental Surgery (D.D.S.), legally entitled to provide dental services. Optometrists, Clinical Psychologists (PhD), and surgical chiropodists are also Providers when legally licensed and giving Covered Services within the scope of their licenses. Plan The arrangement chosen by the Plan Sponsor to fund and provide for delivery of the Employer’s health benefits. Plan Administrator The person or entity named by the Plan Sponsor to manage the Plan and answer questions about Plan details. The Plan Administrator is not the Claims Administrator. Plan Sponsor The legal entity that has adopted the Plan and has authority regarding its operation, amendment and termination. The Plan Sponsor is not the Claims Administrator. Precertification Please see the section “Getting Approval for Benefits” for details. Prescription Drug (Drug) A substance, that under the Federal Food, Drug & Cosmetic Act, must bear a message on its original packing label that says, “Caution: Federal law prohibits dispensing without a prescription.” This includes the following: 1) Compounded (combination) medications, when all of the ingredients are FDA-approved, require a prescription to dispense, and are not essentially the same as an FDA-approved product from a drug manufacturer. 2) Insulin, diabetic supplies, and syringes. Primary Care Physician (“PCP”) A Physician who gives or directs health care services for you. The Physician may work in family practice, general practice, internal medicine, pediatrics, obstetrics/gynecology, geriatrics or any other practice allowed by the Plan. Primary Care Provider A Physician, nurse practitioner, clinical nurse specialist, physician assistant, or any other Provider licensed by law and allowed under the Plan, who gives, directs, or helps you get a range of health care services.
Anthem Blue Access PPO HSA Option E6 IN PPO Large 96R6 01 01 2025 L12026MR02 L12026 English EOC CY Page 116 Page 118