Orange County NC Website
12 <br /> Experimental or Unproven Health Services means those medical, <br /> surgical, psychiatric procedures or treatments and/or pharmacological <br /> products and/or regimes, and associated Health Services not accepted by <br /> the Plan's Utilization Review Committee, taking into consideration the <br /> decisions of the American Medical Association, the Food and Drug <br /> Administration, and other medical/professional groups and associations; <br /> including, but not limited to Sex Change Operations, Gastric Jejunal <br /> Bypass (for purpose of morbid obesity), Silastic Implants, Holiopathic <br /> and/or Megavitamin Therapy. <br /> Family Dependent means a person who meets all applicable eligibility <br /> requirements of Section III of this Contract, who is enrolled hereunder, <br /> and for whom the monthly prepayment has been received by the Plan. <br /> Group means the employer, union, or association which holds the Master <br /> Group Contract with the Plan. <br /> Group Benefit Plan means any indemnity health insurance plan such as <br /> Blue Cross, Blue Shield, or other group health plan that is offered by a <br /> group and covers Subscriber and/or Family Dependents as part of the <br /> group. <br /> Health Services means services and supplies Medically Necessary to <br /> treat Accidental Injuries or Sickness listed as a Covered Health <br /> Service, not listed as an Exclusion. <br /> • Home Health Care means a program of care provided by a duly licensed <br /> and certified agency (a) engaged in providing Home Health Care Services, <br /> including but not limited to, skilled nursing care, and (b). having a <br /> valid existing contract with the Plan to provide said services to <br /> Members. <br /> 8 <br />