Common use of Outpatient Clause in Contracts

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: • Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) • Audiologists • Chiropractors (D.C.) • Counselors • Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) • Dentists (D.D.S. or D.M.D.) • Denturists • Dietitians and Nutritionists (D. or C.D., or C.N.) • Home Health Care, Hospice and Home Care Agencies • Marriage and Family Therapists • Massage Practitioners (L.M.P.) • Midwives • Naturopathic Physicians (N.D.) • Nurses (R.N., L.P.N., A.R.N.P., or N.P.) • Nursing Homes • Occupational Therapists (O.T.A.) • Ocularists • Opticians (Dispensing) • Optometrists (O.D.) • Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) • Osteopathic Physicians (D.O.) • Pharmacists (X.Xx.) • Physical Therapists (L.P.T.) • Physician Assistants (P.A.) (under the supervision of an M.D.) • Physicians (M.D.) • Podiatric Physicians (D.P.M.) • Psychologists (Ph.D.) • Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) • Respiratory Care Practitioners • Social Workers • Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. • Ambulance Companies • Ambulatory Diagnostic, Treatment and Surgical Facilities • Audiologists (CCC-A or CCC-MSPA) • Birthing Centers • Blood Banks • Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts • Community Mental Health Centers • Drug and Alcohol Treatment Facilities • Medical Equipment Suppliers • Hospitals • Kidney Disease Treatment Centers (Medicare-certified) • Psychiatric Hospitals • Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is a provider category regulated under Title 18 or Chapter 70.127 RCW to provide practice health care- related services consistent with state law. Such persons are considered health care providers only to the extent required by RCW 48.43.04548.43.045 and only to the extent services are covered by the provisions of this plan. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare health care facilities and other providers of health care services that are on and supplies, as specifically indicated in the list provider category listing below. Healthcare Health care facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. Covered categories of providers regulated under Title 18 and Chapter 70.127 RCW, will include the following, provided that the services they furnish are consistent with state law and the conditions of coverage described elsewhere in this plan are met. The providers are: •  Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) •  Audiologists •  Chiropractors (D.C.) •  Counselors •  Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) •  Dentists (D.D.S. or D.M.D.) •  Denturists •  Dietitians and Nutritionists (D. or C.D., or C.N.) •  Home Health Care, Hospice and Home Care Agencies •  Marriage and Family Therapists •  Massage Practitioners (L.M.P.) •  Midwives •  Naturopathic Physicians (N.D.) •  Nurses (R.N., L.P.N., A.R.N.P., or N.P.) •  Nursing Homes •  Occupational Therapists (O.T.A.) •  Ocularists •  Opticians (Dispensing) •  Optometrists (O.D.) •  Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) •  Osteopathic Physicians (D.O.) •  Pharmacists (X.Xx.) •  Physical Therapists (L.P.T.) •  Physician Assistants (P.A.) (under the supervision of an M.D.) •  Physicians (M.D.) •  Podiatric Physicians (D.P.M.) •  Psychologists (Ph.D.) •  Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) •  Respiratory Care Practitioners •  Social Workers •  Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. •  Ambulance Companies •  Ambulatory Diagnostic, Treatment and Surgical Facilities •  Audiologists (CCC-A or CCC-MSPA) •  Birthing Centers •  Blood Banks •  Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts •  Community Mental Health Centers •  Drug and Alcohol Treatment Facilities •  Medical Equipment Suppliers •  Hospitals •  Kidney Disease Treatment Centers (Medicare-certified) •  Psychiatric Hospitals •  Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: •  Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) •  Audiologists •  Chiropractors (D.C.) •  Counselors •  Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) •  Dentists (D.D.S. or D.M.D.) •  Denturists •  Dietitians and Nutritionists (D. or C.D., or C.N.) •  Home Health Care, Hospice and Home Care Agencies •  Marriage and Family Therapists •  Massage Practitioners (L.M.P.) •  Midwives •  Naturopathic Physicians (N.D.) •  Nurses (R.N., L.P.N., A.R.N.P., or N.P.) •  Nursing Homes •  Occupational Therapists (O.T.A.) •  Ocularists •  Opticians (Dispensing) •  Optometrists (O.D.) •  Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) •  Osteopathic Physicians (D.O.) •  Pharmacists (X.Xx.) •  Physical Therapists (L.P.T.) •  Physician Assistants (P.A.) (under the supervision of an M.D.) •  Physicians (M.D.) •  Podiatric Physicians (D.P.M.) •  Psychologists (Ph.D.) •  Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) •  Respiratory Care Practitioners •  Social Workers •  Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. •  Ambulance Companies •  Ambulatory Diagnostic, Treatment and Surgical Facilities •  Audiologists (CCC-A or CCC-MSPA) •  Birthing Centers •  Blood Banks •  Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts •  Community Mental Health Centers •  Drug and Alcohol Treatment Facilities •  Medical Equipment Suppliers •  Hospitals •  Kidney Disease Treatment Centers (Medicare-certified) •  Psychiatric Hospitals •  Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. PersonalCare Plan Service Area The PersonalCare Plan service area is King, Pierce and Snohomish counties. All enrolled members must live in this service area in order to be eligible for this plan. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Primary Care Provider (PCP) A provider who both provides primary care and coordinates care to other medical services Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: • Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) • Audiologists • Chiropractors (D.C.) • Counselors • Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) • Dentists (D.D.S. or D.M.D.) • Denturists • Dietitians and Nutritionists (D. or C.D., or C.N.) • Home Health Care, Hospice and Home Care Agencies • Marriage and Family Therapists • Massage Practitioners (L.M.P.) • Midwives • Naturopathic Physicians (N.D.) • Nurses (R.N., L.P.N., A.R.N.P., or N.P.) • Nursing Homes • Occupational Therapists (O.T.A.) • Ocularists • Opticians (Dispensing) • Optometrists (O.D.) • Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) • Osteopathic Physicians (D.O.) • Pharmacists (X.Xx.) • Physical Therapists (L.P.T.) • Physician Assistants (P.A.) (under the supervision of an M.D.) • Physicians (M.D.) • Podiatric Physicians (D.P.M.) • Psychologists (Ph.D.) • Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) • Respiratory Care Practitioners • Social Workers • Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. • Ambulance Companies • Ambulatory Diagnostic, Treatment and Surgical Facilities • Audiologists (CCC-A or CCC-MSPA) • Birthing Centers • Blood Banks • Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- state-licensed in states that have specific licensure for behavior analysts • Community Mental Health Centers • Drug and Alcohol Treatment Facilities • Medical Equipment Suppliers • Hospitals • Kidney Disease Treatment Centers (Medicare-Medicare- certified) • Psychiatric Hospitals • Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Primary Care Provider (PCP) A provider who both provides primary care and coordinates care to other medical services. Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: •  Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) •  Audiologists •  Chiropractors (D.C.) •  Counselors •  Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) •  Dentists (D.D.S. or D.M.D.) •  Denturists •  Dietitians and Nutritionists (D. or C.D., or C.N.) •  Home Health Care, Hospice and Home Care Agencies •  Marriage and Family Therapists •  Massage Practitioners (L.M.P.) •  Midwives •  Naturopathic Physicians (N.D.) •  Nurses (R.N., L.P.N., A.R.N.P., or N.P.) •  Nursing Homes •  Occupational Therapists (O.T.A.) •  Ocularists •  Opticians (Dispensing) •  Optometrists (O.D.) •  Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) •  Osteopathic Physicians (D.O.) •  Pharmacists (X.Xx.) •  Physical Therapists (L.P.T.) •  Physician Assistants (P.A.) (under the supervision of an M.D.) •  Physicians (M.D.) •  Podiatric Physicians (D.P.M.) •  Psychologists (Ph.D.) •  Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) •  Respiratory Care Practitioners •  Social Workers •  Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. •  Ambulance Companies •  Ambulatory Diagnostic, Treatment and Surgical Facilities •  Audiologists (CCC-A or CCC-MSPA) •  Birthing Centers •  Blood Banks •  Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts •  Community Mental Health Centers •  Drug and Alcohol Treatment Facilities •  Medical Equipment Suppliers •  Hospitals •  Kidney Disease Treatment Centers (Medicare-certified) •  Psychiatric Hospitals •  Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. PersonalCare Plan Service Area The PersonalCare Plan service area is King, Pierce and Snohomish counties. All enrolled members must live in this service area in order to be eligible for this plan. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Primary Care Provider (PCP) A provider who both provides primary care and coordinates care to other medical services Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: •  Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) •  Audiologists •  Chiropractors (D.C.) •  Counselors •  Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) •  Dentists (D.D.S. or D.M.D.) •  Denturists •  Dietitians and Nutritionists (D. or C.D., or C.N.) •  Home Health Care, Hospice and Home Care Agencies •  Marriage and Family Therapists •  Massage Practitioners (L.M.P.) •  Midwives •  Naturopathic Physicians (N.D.) •  Nurses (R.N., L.P.N., A.R.N.P., or N.P.) •  Nursing Homes •  Occupational Therapists (O.T.A.) •  Ocularists •  Opticians (Dispensing) •  Optometrists (O.D.) •  Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) •  Osteopathic Physicians (D.O.) •  Pharmacists (X.Xx.) •  Physical Therapists (L.P.T.) •  Physician Assistants (P.A.) (under the supervision of an M.D.) •  Physicians (M.D.) •  Podiatric Physicians (D.P.M.) •  Psychologists (Ph.D.) •  Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) •  Respiratory Care Practitioners •  Social Workers •  Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. •  Ambulance Companies •  Ambulatory Diagnostic, Treatment and Surgical Facilities •  Audiologists (CCC-A or CCC-MSPA) •  Birthing Centers •  Blood Banks •  Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- state-licensed in states that have specific licensure for behavior analysts •  Community Mental Health Centers •  Drug and Alcohol Treatment Facilities •  Medical Equipment Suppliers •  Hospitals •  Kidney Disease Treatment Centers (Medicare-Medicare- certified) •  Psychiatric Hospitals •  Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms::  In-Network Providers are contracted providers that are in your provider network. In-network providers will not bill you for the amount above the allowed amount for a covered service. See the Summary of Your Costs.

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is a provider category regulated under Title 18 or Chapter 70.127 RCW to provide practice health care- related services consistent with state law. Such persons are considered health care providers only to the extent required by RCW 48.43.04548.43.045 and only to the extent services are covered by the provisions of this plan. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare health care facilities and other providers of health care services that are on and supplies, as specifically indicated in the list provider category listing below. Healthcare Health care facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. Covered categories of providers regulated under Title 18 and Chapter 70.127 RCW, will include the following, provided that the services they furnish are consistent with state law and the conditions of coverage described elsewhere in this plan are met. The providers are: • Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) • Audiologists • Chiropractors (D.C.) • Counselors • Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) • Dentists (D.D.S. or D.M.D.) • Denturists • Dietitians and Nutritionists (D. or C.D., or C.N.) • Home Health Care, Hospice and Home Care Agencies • Marriage and Family Therapists • Massage Practitioners (L.M.P.) • Midwives • Naturopathic Physicians (N.D.) • Nurses (R.N., L.P.N., A.R.N.P., or N.P.) • Nursing Homes • Occupational Therapists (O.T.A.) • Ocularists • Opticians (Dispensing) • Optometrists (O.D.) • Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) • Osteopathic Physicians (D.O.) • Pharmacists (X.Xx.) • Physical Therapists (L.P.T.) • Physician Assistants (P.A.) (under the supervision of an M.D.) • Physicians (M.D.) • Podiatric Physicians (D.P.M.) • Psychologists (Ph.D.) • Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) • Respiratory Care Practitioners • Social Workers • Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. • Ambulance Companies • Ambulatory Diagnostic, Treatment and Surgical Facilities • Audiologists (CCC-A or CCC-MSPA) • Birthing Centers • Blood Banks • Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts • Community Mental Health Centers • Drug and Alcohol Treatment Facilities • Medical Equipment Suppliers • Hospitals • Kidney Disease Treatment Centers (Medicare-certified) • Psychiatric Hospitals • Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Prior Authorization Planned services that must be reviewed for medical necessity and approved by us before you receive them. Provider A person in who is in one of the categories listed below that is a provider category regulated under Title 18 or Chapter 70.127 RCW to provide practice health care- related services consistent with state law. Such persons are considered health care providers only to the extent required by RCW 48.43.04548.43.045 and only to the extent services are covered by the provisions of this plan. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare health care facilities and other providers of health care services that are on and supplies, as specifically indicated in the list provider category listing below. Healthcare Health care facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. Covered categories of providers regulated under Title 18 and Chapter 70.127 RCW, will include the following, provided that the services they furnish are consistent with state law and the conditions of coverage described elsewhere in this plan are met. The providers are: •  Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) •  Audiologists •  Chiropractors (D.C.) •  Counselors •  Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) •  Dentists (D.D.S. or D.M.D.) •  Denturists •  Dietitians and Nutritionists (D. or C.D., or C.N.) •  Home Health Care, Hospice and Home Care Agencies •  Marriage and Family Therapists •  Massage Practitioners (L.M.P.) •  Midwives •  Naturopathic Physicians (N.D.) •  Nurses (R.N., L.P.N., A.R.N.P., or N.P.) •  Nursing Homes •  Occupational Therapists (O.T.A.) •  Ocularists •  Opticians (Dispensing) •  Optometrists (O.D.) •  Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) •  Osteopathic Physicians (D.O.) •  Pharmacists (X.Xx.) •  Physical Therapists (L.P.T.) •  Physician Assistants (P.A.) (under the supervision of an M.D.) •  Physicians (M.D.) •  Podiatric Physicians (D.P.M.) •  Psychologists (Ph.D.) •  Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) •  Respiratory Care Practitioners •  Social Workers •  Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. •  Ambulance Companies •  Ambulatory Diagnostic, Treatment and Surgical Facilities •  Audiologists (CCC-A or CCC-MSPA) •  Birthing Centers •  Blood Banks •  Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts •  Community Mental Health Centers •  Drug and Alcohol Treatment Facilities •  Medical Equipment Suppliers •  Hospitals •  Kidney Disease Treatment Centers (Medicare-certified) •  Psychiatric Hospitals •  Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms:

Outpatient. A person who gets healthcare services without an overnight stay in a healthcare facility. This word also describes the services you get while you are an outpatient. Plan The benefits, terms, and limitations stated in this contract. Prescription Drug Drugs and medications that by law require a prescription. This includes biologicals used in chemotherapy to treat cancer. It also includes biologicals used to treat people with HIV or AIDS. According to the Federal Food, Drug and Cosmetic Act, as amended, the label on a prescription drug must have the statement on it: “Caution: Federal law prohibits dispensing without a prescription.” Primary Care Provider (PCP) A provider who both provides primary care and coordinates care to other medical services. Prior Authorization Planned services that must be reviewed for medical necessity and approved before you receive them. Provider A person in who is in one of the categories listed below that is regulated under Title 18 or Chapter 70.127 RCW to provide services consistent with state law. Such persons are considered providers only to the extent required by RCW 48.43.045. Also included is an employee or agent of such a person, acting in the course of and within the scope of his or her employment. To be covered, all providers must be licensed or certified by the State in which they provide services. If the State does not license or certify the type of provider, the provider must be certified as shown on the list. The services they furnish must also be consistent with State law and the terms of coverage in this plan. Providers also include certain healthcare facilities and other providers of services that are on the list below. Healthcare facilities that are owned and operated by a political subdivision or instrumentality of the State of Washington and other such facilities are included as required by state and federal law. The providers are: • Acupuncturists (X.Xx.) (In Washington also called East Asian Medicine Practitioners (E.A.M.P.)) • Audiologists • Chiropractors (D.C.) • Counselors • Dental Hygienists (under the supervision of a D.D.S. or D.M.D.) • Dentists (D.D.S. or D.M.D.) • Denturists • Dietitians and Nutritionists (D. or C.D., or C.N.) • Home Health Care, Hospice and Home Care Agencies • Marriage and Family Therapists • Massage Practitioners (L.M.P.) • Midwives • Naturopathic Physicians (N.D.) • Nurses (R.N., L.P.N., A.R.N.P., or N.P.) • Nursing Homes • Occupational Therapists (O.T.A.) • Ocularists • Opticians (Dispensing) • Optometrists (O.D.) • Osteopathic Physician Assistants (O.P.A.) (under the supervision of a D.O.) • Osteopathic Physicians (D.O.) • Pharmacists (X.Xx.) • Physical Therapists (L.P.T.) • Physician Assistants (P.A.) (under the supervision of an M.D.) • Physicians (M.D.) • Podiatric Physicians (D.P.M.) • Psychologists (Ph.D.) • Radiologic Technologists (C.R.T., C.R.T.T., C.R.D.T., C.N.M.T.) • Respiratory Care Practitioners • Social Workers • Speech-Language Pathologists The following healthcare facilities and other providers will also be considered providers for the purposes of this plan when they meet requirements above. • Ambulance Companies • Ambulatory Diagnostic, Treatment and Surgical Facilities • Audiologists (CCC-A or CCC-MSPA) • Birthing Centers • Blood Banks • Board Certified Behavior Analyst (BCBA), certified by the Behavior Analyst Certification Board, and state- licensed in states that have specific licensure for behavior analysts • Community Mental Health Centers • Drug and Alcohol Treatment Facilities • Medical Equipment Suppliers • Hospitals • Kidney Disease Treatment Centers (Medicare-certified) • Psychiatric Hospitals • Speech Therapists (Certified by the American Speech, Language and Hearing Association) In states other than Washington, "provider" means healthcare practitioners and facilities that are licensed or certified consistent with the laws and regulations of the state in which they operate. This plan makes use of provider networks as explained in How Providers Affect Your Costs. The defined terms below are how we show a provider's network status. For providers of dental care, we use two terms: