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<br />"Semi-Pt'ivate ~cc::'mrI1Ijdatiorls" mearls a two Ot' more bed t'oom in a Hospital, <br />Skilled Nursing Facility or other Approved Health Care Facility or Program. <br />ThE semi-pt'ivõte bed rclc¡m c:har'ge is the filaximwil allowable toward private <br />t'()em acc:onlmodat i,:lt1s. Char'ges fOt' a pt'i ',late r'c"::om wi 11 be paid by the Health <br />Plan if use af a private room is deemed Medically Necessary or Semi-Private <br />Accommodations are not available. <br /> <br />"Set'vic:e At'ea" means the gel::ographic at'ea comprised of Travis, Hays, Lee, <br />Bastrop, Caldwell, Burnet and Williamson counties, Texas. <br /> <br />"ShOt,t-Term" mea'f!5 a Pat'ticipating Physician has determirled that pt'ovisiorl <br />cF therapy will result in a significant improvement in the Covered Person's <br />condition within a period of two (2) months of the start of treatment for <br />said condition. Benefits payable for this therapy are limited to a maximum <br />period of two (2) months for each incident or diagnosis. <br /> <br />"s i cl,mess" <br />III ness. <br /> <br />mea '(IS <br /> <br />physical illness or disease, but does not include Mental <br /> <br />"Skilled Nur'sÌY'lg Facility" mearls arl extended care facility which is <br />licensed as a Skilled Nursing Facility and operated in accordance with the <br />laws of the State of Texas and which is approved by Health Plan or with <br />whclm Health Plan has coY"ltr'acted b::o pr()vide the care described in this <br />C,:,ntr'act. <br /> <br />"SoUY'td Natur'al Teeth" nlearlS teeth that are free of active or chronic <br />clinical decay, have at least 50~ bony support, are functional in the arch, <br />and have not been excessively weakened by multiple dental procedures. <br /> <br />SECTION I I <br />ENROLLMENT AND EFFECTIVE DATE OF INDIVIDUAL COVERAGE <br /> <br />Enro llment <br /> <br />Enro=,llees may erH'oll themselves and their Eligible Dependents dudng the <br />Initial Eligibility Period and Open Enrollment Periods by making <br />application on a form provided or approved by Health Plan. With respect to <br />enrollment of newly acquired Eligible Dependents, an Initial Eligibility <br />Period will be granted begin~ing on the date the individual first becomes <br />an Eligible Dependent. <br /> <br />E'ILde(:ce :)f gr.,::::: tle:dth s,;¡tisf,;.ctory to Health Pla'(! will be ¡-'equired (If any <br />Eligible E~t'ollee or Eligible Dependent whose application is received after <br />th@ir Initial Eligibility Period or Open Enrollment has expired. When <br />evidence of good health is required under this Contract, it shall be <br />pr'ü'Jided at the e><pe':"lse oT the pEt'Son seekirlg to em,,:tll in Health Plan. <br /> <br />If an Em'oUee is also the deper>dent of anotheì' Em',::ollee and are b,:,th <br />eMployed by the same Enrolling Unit, ttlat Enrollee must elect coverage as <br />an Ern-allee. When both hi.,;sband arid wife ar'e Em'clilees, their' Eligible <br />Dependent =hildren mal be covered as Family Dependents of either spouse, <br />but n,:oÌ, both. <br /> <br />The ~~rolling Unit shall notify He~lth Plan in writing within thirty-~ne <br />(3:) days of the effective date of enrollments! terminations or changes in <br />the .::;.:..¡et'.~ge classific¿tion of ar°Y' Erlr'Ql:ee. <br /> <br />GM-12-8 <br />