119 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. Provider A professional or Facility licensed when required by law that gives health care services within the scope of that license, must satisfy our accreditation requirements and be approved by us, on behalf of the Employer. Details on our accreditation requirements can be found at https://www.anthem.com/provider/individual - commercial/join - our - network . This includes any Provider that state law says we must cover when they give you Covered Services. Providers that deliver Covered Services are described throughout this Booklet. If you have a question about a Provider not described in this Booklet please call the number on the back of your Identification Card. Qualifying Payment Amount The median Plan In - Network contract rate we pay In - Network Providers for the geographic area where the service is provided for the same or similar services. Recognized Amount For Surprise Billing Claims, the Recognized Amount is calculated as follows: • For Air Ambulance services, the Recognized Amount is equal to the lesser of the Qualifying Payment Amount as determined under applicable law (generally, the median Plan In - Network contract rate we