1980 002 Ordinance - Laserfiche WebLink

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DEFINITIONS (®ther Than Dental Expense Insurance) klospital - (1) Alegally operated institution primarily providing inpatient medical care and treatment through medical, " - diagnostic and major surgical facilities on its premises, under supervision of a staff of doctors, and with 24- hour-a-day nursing service, or (2) Any other institution accredited as a hospital by the Joint Commission on Accreditation of Hospitals. However, "hospital" does not include a nursing home nor an institution, or part of one, used mainly as a facility for convalescence, nursing, rest, the aged or care of drug addicts. In some states, coverage may also be provided for confinements in certain off-premise facilities such as ambulatory surgical centers, and facilities for treatment of mental illness, drug addiction or alcoholism which do not meet this definition. Your booklet-certificate will indicate if you have such coverage. This definition does not apply to Limited Medical Expense Benefit. For these benefits the definition of hospital is as defined by Medicare. Convalescent Nursing Home-An institution meeting .the following requirements: (1) It is operated legally and primarily provides the following services for convalescents-room, board and 24- hour-a-day nursing service by professional nurses arid such other nurses as are needed to provide adequate medical care. (2) The services are under the full-time supervision of a proprietor or an employee who is a doctor or registered graduate nurse (R.N.). (3) It maintains adequate medical records, and has available doctors' services under an established agreement if not supervised by a doctor. However, "convalescent nursing home" does not include an institution, or part of one, used mainly as a facility for rest, the aged or care of drug addicts. DEFINITIONS (For Dental Expense Insurance ®ption) Treatment Plan-A dentist's report, on a form satisfactory to Prudential, which (1) itemizes the dental services recommended by the dentist for your necessary dental care, (2) shows the dentist's charge for each dental service and (3) is accompanied by supporting pre-operative X-rays. Benefit Year-With respect to an employee and his or her covered dependents, if any, a period of twelve months commencing on the date the employee (not a dependent) became insured or on any anniversary of that date. ELIGIBLE DEPENDENTS Your eligible dependents are your spouse and unmarried children less than 19 years of age. Unmarried children 19 years or over are also eligible provided they wholly depend upon you for support and are full-time students in an educational institution. Persons on active duty in any military, naval or air force are not eligible dependents. Stepchildren, foster children and legally adopted children are considered your children if they wholly depend on you for support. While you remain covered, a dependent child mentally or physically incapacitated from earning a living may continue medical care coverage under the plan if proof of such incapacity is received by Prudential as required. If Dependent Term Life Insurance is provided, children must be 14 days of age or older to be covered, and an upper age exclusion may apply. When dependents health care coverage is a part of the plan,, the newborn children of employees who have not yet elected such coverage are automatically and without charge covered for the first 31 days following birth. C LA I I\/I S Your employer will supply you with claim forms and further information. Should you or your employer need help, see your Prudential representative or consult your telephone directory for the telephone number and address of the local Prudential office. 13