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14 <br /> Participating Physician means a physician who has entered into a <br /> Participating Physician Agreement with the Plan in which he/she agrees <br /> to provide Health Services to Plan Members. <br /> Participating Provider means any Participating Hospital, Skilled <br /> Nursing Facility, Home Health Care Agency, Laboratory, Pharmacy or other <br /> organizations listed in the Plan's Directory of Participating Physicians <br /> and Participating Providers or any amendment to that list. <br /> Plan or the Plan shall mean Carolina Physicians Health Plan, Inc., <br /> whose address is 4020 WestChase Blvd. , suite 450, Raleigh, <br /> North Carolina 27607. <br /> Pre-Admission Certification means the written prior authorization by <br /> the Plan of all inpatient hospital admissions and/or outpatient services. <br /> Pre-existing Condition means an illness, injury or condition that <br /> existed before the effective date with the Plan. <br /> Qualifying Event means the occurrence of an event which affects the <br /> eligibility or continued eligibility of a Member or persons related to <br /> or affiliated with a Member to receive Benefits under the Plan. <br /> (Example: addition or deletion of a Family Dependent.) <br /> Reasonable Fees means fees for covered Health Services and supplies <br /> which do not exceed the average fees for the same service in the <br /> geographic area where the services or supplies are provided. <br /> Semi-Private Room means a two or more bed room in a Hospital, Skilled <br /> Nursing Facility or other Health Care Facility. <br /> Semi-Private Room Rate means the published rate that a hospital <br /> charges for a Semi-Private Room. <br /> 10 <br />