Common use of Mental Health Disorders Clause in Contracts

Mental Health Disorders. ‌ Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. Mental Health Care Provider‌ An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, or accredited by the Joint Commission on Accreditation of Hospitals. Minimum Essential Coverage The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. New Hire‌ A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Non-Covered Services‌ Services that are not benefits specifically provided under the Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Out-of-Network Care‌ Care received by a Member from an Out-of-Network Provider. Out-of-Network Provider‌ A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a Network Provider Contract with Alliant. Out-of-Pocket Limit‌ (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) The maximum amount of a Member’s Co-payment and Coinsurance payments during a given calendar year. Such amount does not include Deductible amounts, charges for non-covered services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit is reached, the level of benefits is increased to 100% of the Maximum Allowed Cost (MAC) for Covered Services. Periodic Health Assessment‌ A medical examination that provides for age-specific preventive services that improve the health and well-being of a patient being examined. This examination is provided through the network by Physicians. The frequency and content of the health assessment are determined by established guidelines and the Member’s personal history. Physical Therapy‌ The care of disease or Injury by such methods as massage, hydrotherapy, heat, or similar care. This service could be provided or prescribed, overseen and billed for by the Physician, or given by a physiotherapist on an Inpatient basis on the orders of a licensed Physician and billed by the Hospital. Physician‌ Any licensed Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, any licensed Doctor of Osteopathy (D.O.) approved by the Composite State Board of Medical Examiners, any licensed Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry and any licensed Doctor of Dental Surgery (D.D.S.) legally entitled to perform oral surgery; Optometrists and Clinical Psychologists (Ph.D.) are also Providers when acting within the scope of their licenses, and when rendering services covered under this Contract. Physician Assistant (PA)‌ An individual duly licensed by the State of Georgia to provide basic medical services under the supervision of a licensed Physician. Physician Assistant Anesthetist (PAA)‌ An individual duly licensed by the State of Georgia to provide anesthesia services under the supervision of a licensed Physician specializing in anesthesia. Plan Administrator‌ The person named by your employer to manage the plan and answer questions about plan details.

Mental Health Disorders. ‌ Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or nonornon-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. Mental Health Care Provider‌ Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Minimum Essential Coverage The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. New Hire‌ Hire A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Non-Covered Services‌ Services that are Any item, service, supply or care not benefits specifically provided listed as a Covered Service under the this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Out-of-Network Care‌ Care Care received by a Member from an Out-of-Network Provider. Out-of-Network Provider‌ Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a an In- Network Provider Contract contract with Alliant. Out-of-Pocket Limit‌ (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) Maximum The maximum amount of a Member’s Co-payment Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Deductible amounts, Premiums or charges for nonNon-covered services Covered Services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit Maximum is reached, the level of benefits is increased to plan pays 100% of the Maximum Allowed Cost (MAC) MAC for Covered Services. Periodic Health Assessment‌ A medical examination that provides for age-specific preventive services that improve the health and well-being of a patient being examined. This examination is provided through the network by Physicians. The frequency and content of the health assessment are determined by established guidelines and the Member’s personal history. Physical Therapy‌ The care of disease or Injury by such methods as massage, hydrotherapy, heat, or similar care. This service could be provided or prescribed, overseen and billed for by the Physician, or given by a physiotherapist on an Inpatient basis on the orders of a licensed Physician and billed by the Hospital. Physician‌ Any licensed Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, any licensed Doctor of Osteopathy (D.O.) approved by the Composite State Board of Medical Examiners, any licensed Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry and any licensed Doctor of Dental Surgery (D.D.S.) legally entitled to perform oral surgery; Optometrists and Clinical Psychologists (Ph.D.) are also Providers when acting within the scope of their licenses, and when rendering services covered under this Contract. Physician Assistant (PA)‌ An individual duly licensed by the State of Georgia to provide basic medical services under the supervision of a licensed Physician. Physician Assistant Anesthetist (PAA)‌ An individual duly licensed by the State of Georgia to provide anesthesia services under the supervision of a licensed Physician specializing in anesthesia. Plan Administrator‌ The person named by your employer to manage the plan and answer questions about plan details.

Mental Health Disorders. ‌ Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-non- chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. Disorders Mental Health Care Provider‌ Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Minimum Essential Coverage The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. New Hire‌ Hire A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Non-Covered Services‌ Services that are Any item, service, supply or care not benefits specifically provided listed as a Covered Service under the this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Out-of-Network Care‌ Care Care received by a Member from an Out-of-Network Provider. Out-of-Network Provider‌ Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a an In- Network Provider Contract contract with Alliant. Out-of-Pocket Limit‌ (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) Maximum The maximum amount of a Member’s Co-payment Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Deductible amounts, Premiums or charges for nonNon-covered services Covered Services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit Maximum is reached, the level of benefits is increased to plan pays 100% of the Maximum Allowed Cost (MAC) MAC for Covered Services. Periodic Health Assessment‌ A medical examination that provides for age-specific preventive services that improve the health and well-being of a patient being examined. This examination is provided through the network by Physicians. The frequency and content of the health assessment are determined by established guidelines and the Member’s personal history. Physical Therapy‌ The care of disease or Injury by such methods as massage, hydrotherapy, heat, or similar care. This service could be provided or prescribed, overseen and billed for by the Physician, or given by a physiotherapist on an Inpatient basis on the orders of a licensed Physician and billed by the Hospital. Physician‌ Any licensed Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, any licensed Doctor of Osteopathy (D.O.) approved by the Composite State Board of Medical Examiners, any licensed Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry and any licensed Doctor of Dental Surgery (D.D.S.) legally entitled to perform oral surgery; Optometrists and Clinical Psychologists (Ph.D.) are also Providers when acting within the scope of their licenses, and when rendering services covered under this Contract. Physician Assistant (PA)‌ An individual duly licensed by the State of Georgia to provide basic medical services under the supervision of a licensed Physician. Physician Assistant Anesthetist (PAA)‌ An individual duly licensed by the State of Georgia to provide anesthesia services under the supervision of a licensed Physician specializing in anesthesia. Plan Administrator‌ The person named by your employer to manage the plan and answer questions about plan details.

Mental Health Disorders. ‌ Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. Mental Health Care Provider‌ Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Minimum Essential Coverage The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. New Hire‌ A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Non-Covered Services‌ Services that are Any item, service, supply or care not benefits specifically provided listed as a Covered Service under the this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Out-of-Network Care‌ Care Care received by a Member from an Out-of-Network Provider. Out-of-Network Provider‌ Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a an In- Network Provider Contract contract with Alliant. Out-of-Pocket Limit‌ (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) Maximum The maximum amount of a Member’s Co-payment Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Deductible amounts, Premiums or charges for nonNon-covered services Covered Services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit Maximum is reached, the level of benefits is increased to plan pays 100% of the Maximum Allowed Cost (MAC) MAC for Covered Services. Periodic Health Assessment‌ Outpatient A Member who receives medical examination treatment without being admitted to a hospital. Outpatient Prescription Drug Formulary A document setting forth certain rules relating to the coverage of pharmaceuticals by us that provides for agemay include but not be limited to (1) a listing of preferred and non-specific preventive services preferred prescription medications that improve the health are covered and/or prioritized in order of preference by us and well-being of a patient being examinedare dispensed to Members through pharmacies that are Network Providers, and (2) Prior Authorization rules. This examination list is provided through subject to periodic review and modification by us, at our sole discretion. Charges for medications may be Ineligible Charges, in whole or in part, if a Member selects a medication not included in the network by Physicians. The frequency and content of the health assessment are determined by established guidelines and the Member’s personal historyDrug Formulary. Physical Therapy‌ Therapy The care of disease or Injury by such methods as massage, hydrotherapy, heat, or similar care. This service could be provided or prescribed, overseen and billed for by the Physician, or given by a physiotherapist on an Inpatient basis on the orders of a licensed Physician and billed by the Hospital. Physician‌ Any licensed Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, any licensed Doctor of Osteopathy (D.O.) approved by the Composite State Board of Medical Examiners, any licensed Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry and any licensed Doctor of Dental Surgery (D.D.S.) legally entitled to perform oral surgery; Optometrists and Clinical Psychologists (Ph.D.) are also Providers when acting within the scope of their licenses, and when rendering services covered under this Contract. Physician Assistant (PA)‌ An individual duly licensed by the State of Georgia to provide basic medical services under the supervision of a licensed Physician. Physician Assistant Anesthetist (PAA)‌ An individual duly licensed by the State of Georgia to provide anesthesia services under the supervision of a licensed Physician specializing in anesthesia. Plan Administrator‌ The person named by your employer to manage the plan and answer questions about plan details.

Mental Health Disorders. ‌ Includes (whether organic or non-organic, whether of biological, non-biological, genetic, chemical or non-chemical origin, and irrespective of cause, basis or inducement) mental disorders, mental illnesses, psychiatric illnesses, mental conditions, psychiatric conditions and drug, alcohol or chemical dependency. This includes, but is not limited to, psychoses, neurotic disorders, schizophrenic disorders, affective disorders, chemical dependency disorders, personality disorders, and psychological or behavioral abnormalities associated with transient or permanent dysfunction of the brain or related neurohormonal systems. This is intended to include disorders, conditions, and illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders. Mental Health Care Provider‌ Provider An institution such as a Hospital or ambulatory care facility established for the diagnosis and treatment of mental illness. The facility must have diagnostic and therapeutic facilities for care and treatment provided by or under the supervision of a licensed Physician. The facility must be operated in accordance with the laws of the State of Georgia, Georgia or accredited by the Joint Commission on Accreditation of Hospitals. Minimum Essential Coverage The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage. New Hire‌ A person who is employed by the Group after the original Effective Date of the Group health plan coverage. Non-Covered Services‌ Services that are Any item, service, supply or care not benefits specifically provided listed as a Covered Service under the this Contract, are excluded by the Contract, are provided by an Ineligible Provider, or are otherwise not eligible to be Covered Services, whether or not they are Medically Necessary. Nurse Practitioner (NP) An individual duly licensed by the State of Georgia to provide primary nursing and basic medical services. Out-of-Network Care‌ Care Care received by a Member from an Out-of-Network Provider. Out-of-Network Provider‌ Provider A Hospital, Physician, Skilled Nursing Facility, Hospice, Home Health Care Agency, other medical practitioner or provider of medical services and supplies, that does not have a an In- Network Provider Contract contract with Alliant. Out-of-Pocket Limit‌ (May apply to In-Network or Out-of-Network—Refer to Summary of Benefits and Coverage’s) Maximum The maximum amount of a Member’s Co-payment Copayments and Coinsurance payments (including any required Deductible) during a given calendar year. Out-of-Pocket Maximums are accumulated separately for In-Network and Out-of-Network Care as defined in the Summary of Benefits and Coverage. Such amount does not include Deductible amounts, Premiums or charges for nonNon-covered services Covered Services or fees in excess of the Maximum Allowed Cost (MAC). When the Out-of-Pocket Limit Maximum is reached, the level of benefits is increased to plan pays 100% of the Maximum Allowed Cost (MAC) MAC for Covered Services. Periodic Health Assessment‌ A medical examination that provides for age-specific preventive services that improve the health and well-being of a patient being examined. This examination is provided through the network by Physicians. The frequency and content of the health assessment are determined by established guidelines and the Member’s personal history. Physical Therapy‌ The care of disease or Injury by such methods as massage, hydrotherapy, heat, or similar care. This service could be provided or prescribed, overseen and billed for by the Physician, or given by a physiotherapist on an Inpatient basis on the orders of a licensed Physician and billed by the Hospital. Physician‌ Any licensed Doctor of Medicine (M.D.) legally entitled to practice medicine and perform surgery, any licensed Doctor of Osteopathy (D.O.) approved by the Composite State Board of Medical Examiners, any licensed Doctor of Podiatric Medicine (D.P.M.) legally entitled to practice podiatry and any licensed Doctor of Dental Surgery (D.D.S.) legally entitled to perform oral surgery; Optometrists and Clinical Psychologists (Ph.D.) are also Providers when acting within the scope of their licenses, and when rendering services covered under this Contract. Physician Assistant (PA)‌ An individual duly licensed by the State of Georgia to provide basic medical services under the supervision of a licensed Physician. Physician Assistant Anesthetist (PAA)‌ An individual duly licensed by the State of Georgia to provide anesthesia services under the supervision of a licensed Physician specializing in anesthesia. Plan Administrator‌ The person named by your employer to manage the plan and answer questions about plan details.