Noblesville Schools Medical Plan 102 Section 9: Defined Terms Dependent - the Participant's legal spouse or a child of the Participant or the Participant's spouse. As described in Section 3: When Coverage Begins, the Plan Sponsor determines who is eligible to enroll and who qualifies as a Dependent. The term "child" includes: • A natural child. • A stepchild. • A legally adopted child. • A child placed for adoption. • A child for whom legal guardianship has been awarded to the Participant or the Participant's spouse. • A child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order. The Plan Sponsor is responsible for determining if an order meets the criteria of a Qualified Medical Child Support Order. The following conditions apply: • A dependent includes a child listed above under age 26. A child who meets the requirements set forth above ceases to be eligible as described in Section 4: When Coverage Ends. The Participant must reimburse the Plan for any Benefits paid during a time a child did not satisfy these conditions. A Dependent does not include anyone who is also enrolled as a Participant. No one can be a Dependent of more than one Participant. Designated Dispensing Entity - a pharmacy provider, or facility that has entered into an agreement with the Claims Administrator, or with an organization contracting on the Claims Administrator's behalf, to provide Pharmaceutical Products for the treatment of specified diseases or conditions. Not all Network pharmacies, providers, or facilities are Designated Dispensing Entities. Designated Network Benefits - the description of how Benefits are paid for certain Covered Health Care Services provided by a provider or facility that has been identified as a Designated Provider. The Schedule of Benefits will tell you if your plan offers Designated Network Benefits and how they apply. Designated Provider - a provider and/or facility that: • Has entered into an agreement with the Claims Administrator, or with an organization contracting on the Claims Administrator's behalf, to provide Covered Health Care Service for the treatment of specific diseases or conditions; or • The Claims Administrator has identified through the Claims Administrator's designation programs as a Designated Provider. Such designation may apply to specific treatments, conditions and/or procedures. A Designated Provider may or may not be located within your geographic area. Not all Network Hospitals or Network Physicians are Designated Providers. You can find out if your provider is a Designated Provider by contacting the Claims Administrator at www.myuhc.com or the telephone number on your ID card. Designated Virtual Network Provider - a provider or facility that has entered into an agreement with the Claims Administrator, or with an organization contracting on the Claims Administrator's behalf, to deliver Covered Health Care Services through live audio with video technology or audio only. Durable Medical Equipment (DME) - medical equipment that is all of the following: • Ordered or provided by a Physician for outpatient use primarily in a home setting.