116 Definitions If a word or phrase in this Booklet has a special meaning, such as Medical Necessity or Experimental / Investigational, it will start with a capital letter, and be defined below. If you have questions on any of these definitions, please call Member Services at the number on the back of your Identification Card. Accidental Injury An unexpected Injury for which you need Covered Services while enrolled in this Plan. It does not include injuries that you get benefits for under any Workers’ Compensation, Employer’s liability or similar law. Ambulatory Surgery Center A facility licensed as an Ambulatory Surgery Center as required by law that must satisfy our accreditation requirements and be approved by us. Approved In-Network Provider Please see the “Human Organ and Tissue Transplant (Bone Marrow / Stem Cell), Cellular and Gene Therapy Services” benefit in the “What’s Covered” section. Athletic Trainer Please see the “Athletic Trainer Services” benefit in the “What’s Covered” section for details. Administrative Services Agreement The agreement between the Claims Administrator and the Employer regarding the administration of certain elements of the health care benefits of the Employer's Group Health Plan. Authorized Service(s) A Covered Service you get from an Out-of-Network Provider that we, on behalf of the Employer, have agreed to cover at the In-Network level. You will have to pay any In-Network Deductible, Coinsurance, and/or Copayment(s) that apply, and may also have to pay the difference between the Maximum Allowed Amount and the Out-of-Network Provider’s charge unless your claim is a Surprise Billing Claim. Please see the “EXPERIMENTAL OR INVESTIGATIONAL SERVICES EXCLUSION Any Drug, biologic, device, diagnostic, product, equipment, procedure, treatment, service, or supply, used in or directly related to the diagnosis, evaluation, or treatment of a disease, injury, illness, or other health problem which is determined to be Experimental or Investigational is not covered by your Plan. The Plan will deem any Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply to be Experimental or Investigational if determined that one of more of the criteria listed below apply when the service is rendered with respect to the use for which benefits are sought. The Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply: • cannot be legally marketed in the United States without the final approval of the Food and Drug Administration (FDA), or other licensing or regulatory agency, and such final approval has not been granted; • has been determined by the FDA to be contraindicated for the specific use; or • is subject to review and approval of an Institutional Review Board (IRB) or other body serving a similar function; or • is given because of informed consent documents that describe the Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply as Experimental or Investigational, or