Dependent Dependents are:
Medicaid The term Medicaid means a state program of medical aid for needy persons established under Title XIX of the Social Security Act of 1965 as amended.
your lawful spouse; and any child of yours who is less than 26 years old.
HC-DFS16
04-10
26 or more years old, unmarried, and primarily supported by you and incapable of self-sustaining employment by reason of mental or physical disability. Proof of the child's condition and dependence may be required to be submitted to the plan within 31 days after the date the child ceases to qualify above. From time to time, but not more frequently than once a year, the plan may require proof of the continuation of such condition and dependence. The term child means a child born to you or a child legally adopted by you. It also includes a stepchild, a foster child, or a child for whom you are the legal guardian. Benefits for a Dependent child will continue until the last day of the calendar month in which the limiting age is reached. No one may be considered as a Dependent of more than one Employee.
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Medically Necessary/Medical Necessity Medically Necessary Covered Services and Supplies are those determined by the Medical Director to be: required to diagnose or treat an illness, injury, disease or its symptoms; in accordance with generally accepted standards of medical practice; clinically appropriate in terms of type, frequency, extent, site and duration; not primarily for the convenience of the patient, Physician or other health care provider; and rendered in the least intensive setting that is appropriate for the delivery of the services and supplies. Where applicable, the Medical Director may compare the cost-effectiveness of alternative services, settings or supplies when determining least intensive setting.
HC-DFS875 M
01-17
Employee The term Employee means a full-time employee of the Employer who is currently in Active Service. The term does not include employees who are part-time or temporary or who normally work less than 30 hours a week for the Employer.
HC-DFS19
04-10
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Medicare The term Medicare means the program of medical care benefits provided under Title XVIII of the Social Security Act of 1965 as amended.
HC-DFS1094 M
12-17
Employer The term Employer means the plan sponsor self-insuring the benefits described in this booklet, on whose behalf Cigna is providing claim administration services.
HC-DFS17
04-10
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Ophthalmologist The term Ophthalmologist means a person practicing ophthalmology within the scope of his license. It will also include a physician operating within the scope of his license when he performs any of the Vision Care services described in the policy.
HC-DFS8
04-10
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Injury The term Injury means an accidental bodily injury.
HC-DFS70
04-10
HC-DFS12
04-10
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