Common use of Covered Dependent Clause in Contracts

Covered Dependent. Any Dependent in a Subscriber’s family who meets all the requirements of the Eligibility section of this Certificate and has enrolled and complied with the Premium requirements. Covered Services Those charges for Medically Necessary health care services, treatment and supplies intended to improve a condition or Member’s health that are (a) defined as Covered Services in the Member’s Contract, (b) not excluded under such Contract, (c) not Experimental or Investigational and (d) provided in accordance with such Contract. Covered Services are determined based upon all other Contract provisions. When more than one treatment option is available, and one option is no more effective than another, the Covered Service is the least costly option that is no less effective than any other option. The Covered Services are also subject to the Maximum Allowable Cost (MAC), as defined herein and all Contract exclusions will be taken into consideration to determine the Covered Service. Creditable Coverage Coverage under another health benefit plan is medical expense coverage with no greater than a ninety (90) day gap in coverage under any of the following: (a) Medicare or Medicaid; (b) an employer-based accident and sickness insurance or health benefit arrangement; (c) an individual accident and sickness insurance policy; (d) a spouse’s benefits or coverage under Medicare or Medicaid or an employer-based health insurance benefit arrangement; (e) a conversion policy; or similar coverage as defined in OCGA 33-30-15.

Covered Dependent. Any Dependent in a Subscriber’s family who meets all the requirements of the Eligibility section of this Certificate and has enrolled and complied with the Premium requirements. Covered Services Those charges for Medically Necessary health care services, treatment and supplies intended to improve a condition or Member’s health that are (a) defined as Covered Services in the Member’s Contract, (b) not excluded under such Contract, (c) not Experimental or Investigational and (d) provided in accordance with such Contract. Covered Services are determined based upon all other Contract provisions. When more than one treatment option is available, and one option is no more effective than another, the Covered Service is the least costly option that is no less effective than any other option. The Covered Services are also subject to the Maximum Allowable Cost (MAC), as defined herein and all Contract exclusions will be taken into consideration to determine the Covered Service. Creditable Coverage Coverage under another health benefit plan is medical expense coverage with no greater than a ninety (90) day gap in coverage under any of the following: (a) Medicare or Medicaid; (b) an employer-based accident and sickness insurance or health benefit arrangement; (c) an individual accident and sickness insurance policy; (d) a spouse’s benefits or coverage under Medicare or Medicaid or an employer-based health insurance benefit arrangement; (e) a conversion policy; or similar coverage as defined in OCGA 33-30-15.;