114 A facility including but not limited to, a Hospital, freestanding Ambulatory Surgery Center, Residential Treatment Center, or Skilled Nursing Facility, as defined in this Booklet. The Facility must be licensed as required by law, satisfy our accreditation requirements, and be approved by us. Fee(s) The amount you must pay to be covered by this Plan. Home Health Care Agency 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. In-Network Provider A Provider that has a contract, either directly or indirectly, with us, or another organization, to give Covered Services to Members through negotiated payment arrangements. A Provider that is In-Network for one plan may not be In-Network for another. Please see “How to Find a Provider in the Network” in the section “How Your Plan Works” for more information on how to find an In-Network Provider for this Plan. 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.
Anthem Blue Access PPO Option 23 with Rx Option T3 IN PPO Large 96R4 01 01 2025 L12026M001 L12026 English EOC CY Page 114 Page 116