Orange County NC Website
13 <br /> Hospital means an acute general care facility operated pursuant to law <br /> which (a) is primarily engaged in providing, for compensation from its <br /> patients, diagnostic therapeutic facilities for surgical or medical <br /> diagnosis, treatment, and care of injured and sick persons by, or under <br /> the supervision of, a staff of physicians; (b) has 24-hour nursing <br /> services by registered professional nurses; and (3) is not a Federal <br /> Hospital; or (4) is not, other than incidentally, a place for rest, <br /> custodial care, or the aged; or nursing home, convalescent home or <br /> similar institution. <br /> Master Group Contract means this contract between the Plan and the <br /> Group. <br /> Medically Necessary means any Health Services required to preserve and <br /> maintain the Member's health as determined by acceptable standards of <br /> medical practice. The Plan's Medical Director shall have the authority <br /> to determine whether any health care rendered to a Member is Medically <br /> Necessary. <br /> Medicare means the Health Insurance for Aged and Disabled Program <br /> established pursuant to Title XVIII, United States Social Security Act, <br /> as now in effect or hereafter amended. <br /> Member means a Subscriber and/or Family Dependent. <br /> Membership Card means the card that the Plan issues to its Members <br /> showing that they are entitled to receive Health Services from <br /> Participating Physicians and Participating Providers. <br /> Mental Health Conditions means mental, nervous, or emotional disorders <br /> subject to significant clinical improvement through Short-Term <br /> Rehabilitation Services. <br /> Open Enrollment Period means a pre-determined period, established by <br /> the Group and the Plan, during which eligible members of a Group can <br /> apply for Coverage without any pre-existing conditions. <br /> 9 <br />