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<br />b. <br /> <br />Its services are provided for compensation from its patients and <br />under the full-time supervision of a physician or registered <br />graduate nurse; and <br /> <br />c. <br /> <br />It provides 24 hour per day nursing services by licensed nurses, <br />under the direction of a full-time registered graduate nurse; and <br /> <br />d. <br /> <br />It maintains a complete medical record on each patient; and <br /> <br />e. <br /> <br />It has an effective utilization review plan; and <br /> <br />f. <br /> <br />It is not, other than incidentally, a place for rest, the aged, drug <br />addicts, alcoholics, mental retardates, custodial or education care, <br />or care of mental disorders; and <br /> <br />g. <br /> <br />It is approved and licensed by Medicare. <br /> <br />This term shall also apply to expenses incurred in an institution referring to <br />itself as a Skilled Nursing Facility, Extended Care Facility, Convalescent <br />Nursing Home, or any such other similar nomenclature. <br /> <br />CONVALESCENT PERIOD <br /> <br />The term "Convalescent Period" means a period of time commencing with the date <br />of confinement by a Covered Person to a Convalescent Nursing Facility. Such <br />confinement must meet all of the following conditions: <br /> <br />a. <br /> <br />Such confinement must commence wi thin fourteen (14) days of being <br />discharged from a hospital; and <br /> <br />b. <br /> <br />Said hospital confinement must have been for a period of not less <br />than three (3) consecutive days; and <br /> <br />c. <br /> <br />Both the hospital and convalescent confinements must have been for <br />the care and treatment of the same illness or injury. <br /> <br />A convalescent Period will terminate when the Covered Person has been free of <br />confinement in any and all institutions providing hospital or nursing care for <br />a period of ninety (90) consecutive days. A new convalescent period shall not <br />commence until a previous convalescent period has terminated. <br /> <br />COS~ŒTIC PROCEDURE <br /> <br />The term "Cosmetic Procedure" means a procedure performed solely for the <br />improvement of a Covered Person's appearance rather than for the improvement <br />of restoration of bodily functions. <br /> <br />COVERED EXPENSES <br /> <br />The term "Covered Expenses" means any medically necessary treatments, <br />services, or supplies that are not specifically excluded from coverage <br />elsewhere in this Plan. <br /> <br />9 <br />