Noblesville Schools Medical Plan 101 Section 9: Defined Terms The Schedule of Benefits will tell you if your plan is subject to payment of an Annual Deductible and how it applies. Autism Spectrum Disorder - a condition marked by enduring problems communicating and interacting with others, along with restricted and repetitive behavior, interests or activities, and as listed in the current edition of the International Classification of Diseases section on Mental and Behavioral Disorders or the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Benefits - your right to payment for Covered Health Care Services that are available under the Plan. Cellular Therapy - administration of living whole cells into a patient for the treatment of disease. Claims Administrator - the organization that provides certain claim administration and other services for the Plan. Coinsurance - the charge, stated as a percentage of the Allowed Amount or the Recognized Amount when applicable, that you are required to pay for certain Covered Health Care Services. Congenital Anomaly - a physical developmental defect that is present at the time of birth, and that is identified within the first twelve months of birth. Copayment - the charge, stated as a set dollar amount, that you are required to pay for certain Covered Health Care Services. Please note that for Covered Health Care Services, you are responsible for paying the lesser of the following: • The Copayment. • The Allowed Amount, or the Recognized Amount when applicable. Cosmetic Procedures - procedures or services that change or improve appearance without significantly improving physiological function. Covered Health Care Service(s) - health care services, including supplies or Pharmaceutical Products, which the Claims Administrator determines to be all of the following: • Provided for the purpose of preventing, evaluating, diagnosing or treating a Sickness, Injury, Mental Illness, substance-related and addictive disorders, condition, disease or its symptoms. • Medically Necessary. • Described as a Covered Health Care Service in this SPD under Section 1: Covered Health Care Services and in the Schedule of Benefits. • Not excluded in this SPD under Section 2: Exclusions and Limitations. Covered Person - the Participant or a Dependent, but this term applies only while the person is enrolled under the Plan. The Plan Sponsor uses "you" and "your" in this SPD to refer to a Covered Person. Custodial Care - services that are any of the following non-Skilled Care services: • Non health-related services such as help with daily living activities. Examples include eating, dressing, bathing, transferring and ambulating. • Health-related services that can safely and effectively be performed by trained non-medical personnel and are provided for the primary purpose of meeting the personal needs of the patient or maintaining a level of function, as opposed to improving that function to an extent that might allow for a more independent existence. Definitive Drug Test - test to identify specific medications, illicit substances and metabolites and is qualitative or quantitative to identify possible use or non-use of a drug.