PLAN OF TREATMENT. a plan of care which is developed or approved by a Member’s Primary Care Physician for the treatment of an injury or illness. The Plan of Treatment should be limited in scope and extent to that care which is Medically Necessary for the Member's diagnosis and condition. PREAUTHORIZATION – An authorization (or approval) from Keystone Health Plan Central or its designee which results from a process utilized to determine member eligibility at the time of request, benefit coverage PREMIUM – The payment due for coverage under this Agreement. PROFESSIONAL PROVIDER – a person or practitioner who is certified, registered or who is licensed and performing services within the scope of such licensure. The Professional Providers are: PROVIDER – A hospital, physician, person or practitioner licensed (where required) and performing services within the scope of such licensure and as identified in this Agreement. Providers include participating providers and non-participating providers. QUALIFIED HEALTH PLAN or QHP – Qualified Health Plan or QHP means a health plan that has in effect a certification from the United Stated Secretary of Health and Human Services that it is certified to be offered on the Exchange/Marketplace.
Appears in 5 contracts
Samples: Individual Hmo Subscriber Agreement, Hmo Subscriber Agreement, Hmo Subscriber Agreement
