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DEFINITIONS

The following are terms used in this booklet and other materials connected with this Health Plan. When a defined term is used, it will have the meaning set forth in this section and it will be capitalized in the text. Any capitalized words not defined in this section that have precise meanings will be defined where they are used in the text.

1 . Hospital. Any hospital in the Service Area to which a member is admitted pursuant to arrangements made by a Medical Group Physician.

2. Medical Group. The Colorado Permanente Medical Group, P.C.

3. Medical Office. Any outpatient treatment facility staffed by Medical Group Physicians.

4. Medically Necessary. A service or item is medically necessary only if a Medical Group Physician determines that its omission would adversely affect a member's health, and its provision constitutes a medically appropriate course of treatment for the member.

5. Non-Member Rates. The charges in the applicable schedule of charges maintained by Medical Group or Hospitals for services provided to patients who are not members.

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NAVIGATION

Introduction | Benefit Changes | How to Use | Definitions | How Your Plan Works | Who Is Eligible | When Coverage Starts | Benefits And Services | Referrals and Restrictions on Choice of Providers | Emergency Services | Urgent Care | Health Plan's Appeals Procedure | Special Claims Procedures for Medicare Members | General Provisions | Binding Arbitration | Coordination Of currentbenefits | Medicare | What Is Not Covered | When Coverage Stops | Continuation Of Coverage | Customer Satisfaction Procedure | Service Information | Statement Of Financial Condition | Important Phone Numbers