Expense Incurred An expense is incurred when the service or the supply for which it is incurred is provided.
Hospice Care Program The term Hospice Care Program means: a coordinated, interdisciplinary program to meet the physical, psychological, spiritual and social needs of dying persons and their families; a program that provides palliative and supportive medical, nursing and other health services through home or inpatient care during the illness; a program for persons who have a Terminal Illness and for the families of those persons.
HC-DFS10
04-10
V1
Free-Standing Surgical Facility The term Free-standing Surgical Facility means an institution which meets all of the following requirements: it has a medical staff of Physicians, Nurses and licensed anesthesiologists; it maintains at least two operating rooms and one recovery room; it maintains diagnostic laboratory and x-ray facilities; it has equipment for emergency care; it has a blood supply; it maintains medical records; it has agreements with Hospitals for immediate acceptance of patients who need Hospital Confinement on an inpatient basis; and it is licensed in accordance with the laws of the appropriate legally authorized agency.
HC-DFS51
04-10
V1
Hospice Care Services The term Hospice Care Services means any services provided by: a Hospital, a Skilled Nursing Facility or a similar institution, a Home Health Care Agency, a Hospice Facility, or any other licensed facility or agency under a Hospice Care Program.
HC-DFS52
04-10
V1
Hospice Facility The term Hospice Facility means an institution or part of it which: primarily provides care for Terminally Ill patients; is accredited by the National Hospice Organization; meets standards established by Cigna; and fulfills any licensing requirements of the state or locality in which it operates.
HC-DFS11
04-10
V1
Generic Drug A Prescription Drug Product that Cigna identifies as a Generic Drug product at a book-of-business level principally based on available data resources, including, but not limited to, First DataBank or another nationally recognized drug indicator source, that classify drugs or Biologics (including Biosimilars) as either brand or generic based on a number of factors. Not all products identified as a “generic” by the manufacturer, Pharmacy or your Physician may be classified as a Generic Drug under the plan. A Biosimilar may be classified as a Generic Drug for the purposes of benefits under the plan even if it is identified as a “brand name” drug by the manufacturer, Pharmacy or your Physician.
HC-DFS53
04-10
V1
Hospital The term Hospital means: an institution licensed as a hospital, which: maintains, on the premises, all facilities necessary for medical and surgical treatment; provides such treatment on an inpatient basis, for compensation, under the supervision of Physicians; and provides 24-hour service by Registered Graduate Nurses; an institution which qualifies as a hospital, a psychiatric hospital or a tuberculosis hospital, and a provider of
HC-DFS846
10-16
69
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