Utilization Review Manager/Utilization Management means Adventist Health Benefits Administration’s in-house utilization review department, which is responsible for determining whether requested medical care is medically necessary. However, for all prescription drug […]
Medical Condition means any condition of an enrollee resulting from illness, injury (whether or not the injury is accidental), pregnancy or congenital malformation. However, genetic information is not a medical […]
Hospital means a facility that is licensed as an acute care general hospital and provides in-patient surgical and medical care to persons who are acutely ill. Additionally, the facility’s services […]
ACA Out-of-Pocket Maximum ACA Out-of-Pocket Maximum is $9100 per person and $18,200 per family in 2023. Except as otherwise specified, unreimbursed in-network covered services that are medical or prescription drug […]
This resource is intended for: RetireeEmployeeEmployerAll information on this Web site is copyrighted by the local website sponsor under license with the North American Division of Seventh-day Adventists®. All rights are reserved. United States copyright […]
This resource is intended for: RetireeEmployeeEmployerSHARP-Ex means the medical and prescription drug benefits offered through the private Medicare Exchange Marketplace vendor, Alight Retiree Health Solutions.