Enrollment Date. With respect to a Federally Defined Eligible Individual means the date the person submits a substantially complete application for coverage. With respect to all other persons, Enrollment Date means the Effective Date of coverage under this Contract for the person. Services or supplies which We Determine are: not of proven benefit for the particular diagnosis or treatment of a [Member]'s particular condition; or not generally recognized by the medical community as effective or appropriate for the particular diagnosis or treatment of a [Member]'s particular condition; or provided or performed in special settings for research purposes or under a controlled environment or clinical protocol. Unless otherwise required by law with respect to drugs which have been prescribed for treatment for which the drug has not been approved by the United States Food and Drug Administration (FDA), We will not cover any services or supplies, including treatment, procedures, drugs, biological products or medical devices or any hospitalizations in connection with Experimental or Investigational services or supplies. We will also not cover any technology or any hospitalization in connection with such technology if such technology is obsolete or ineffective and is not used generally by the medical community for the particular diagnosis or treatment of a [Member]'s particular condition. Governmental approval of a technology is not necessarily sufficient to render it of proven benefit or appropriate or effective for a particular diagnosis or treatment of a [Member]'s particular condition, as explained below. We will apply the following five criteria in Determining whether services or supplies are Experimental or Investigational:
Appears in 4 contracts
Samples: Hmo Health Benefits Contract, Hmo Contract, Hmo Contract
