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Res 1988-077
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Res 1988-077
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Last modified
8/9/2007 11:15:13 AM
Creation date
8/9/2007 11:15:13 AM
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City Clerk
City Clerk - Document
Resolutions
City Clerk - Type
Contract
Number
1988-77
Date
7/11/1988
Volume Book
91
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<br />(4) <br /> <br />In )'"ICi ever,t shall the te~'m "Family Dependent" include any child <br />who is eligible for coverage under this Contract as an Enrollee. <br /> <br />"Heal th Se~--vices" <br />this Corltt'act. <br /> <br />mearls <br /> <br />health care services or benefits provided fCir in <br /> <br />"Health Set'vice Fee" rnearlS the monthly fee required for each Enrollee and <br />Family Dependent in accordance with the terms of this Contract. <br /> <br />"Home Health Agericy" mear,s a facility or pt'clgt'am which is licerlsed, <br />certified or otherwise authorized pursuant to the laws of the State of <br />Te;(as as a H';:lme Health Agel')cy and is app~'()ved by Health Plan or with whom <br />Heal th Plan has cl:)ntt'acted to prl:)vide the Health Set'vice covered under this <br />Cçmt t'¿¡ct . <br /> <br />"Hospi tal" means an inst i tut i,:)r, I:)perated pursuant to law which (1) is <br />primat'i ly engaged ir, pt'oviding, f,:)t' cclmpensat ion ft'()m its pat ients, <br />diagnostic and surgical facilities for the care and treatment of injured or <br />sick individuals by, or under the supervision of, a staff of Physicians, <br />(2) has 24-hout' nursirlg services by registered graduate nurses (R. N. ), and <br />(3) is not primarily a place for rest, custodial care of the aged, or <br />nut'sing hQme, convalescent h,:.me Ot' similar i.nstituticm. <br /> <br />"Initial Eligibility Period" means <br />application of the Enrolling Unit <br />application for enrollment in Health <br />without providing evidence of good <br />specified in this Contract. <br /> <br />the period of time specified in the <br />during which an Enrollee may make <br />Plan for self and Eligible Dependents <br />heal th sat isfactl:)t'y to Health Plan as <br /> <br />"IrIJury" means bodily damage including all related conditions and recurrent <br />symptoms. <br /> <br />IILIJng Term" means any therapy beyond the two (2) months as covered in the <br />Schedule of Benefits. <br /> <br />"Materni ty" means pre/PQst partum care, ch i ldbirth, eat'ly terminat ion of <br />pt'egnancy, ':Jt' any cl:.mp Ii cat i on ad sing t het'efrom for' a CQvet'ed Pet'son. <br /> <br />"Medically Necessat,y" means medical or surgical tt'eatment which a Covered <br />Person requires as determined by a Participating Primary Care Physician or <br />by a phy~ician in an Emergency as defined herein in accordance with <br />accepted medical and surgical practice and 5tandards prevailing at the time <br />CI f tt'ea t ment . <br /> <br />"~1edicare" mearls the insllt'ance pt'ogram established by Title XVIII, United <br />States Social Secut'ity Act, as originally enacted by the Social Security <br />Amendments of 1965, or as later amended. <br /> <br />"Medicat'e Eligible" means an empl':Jyee, t'etit'ee, spouse I:)t' dependent child <br />who (1) meets the eligibility requirements of the Enrolling Unit; and (2) <br />is enrolled in both parts A and B of Medicare; and (3) agrees to assign all <br />Medicare benefits to the Health Plan. <br /> <br />"Mental Heal th Set'vices" meiCins those set'vices and suppl ies cl:Jvet'ed ,-mdet' <br />~his Contract fGr the diagnosis and treatment of Mental Illness. <br /> <br />GM-12-6 <br />
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