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 […]
All 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: RetireeEmployeeEmployerUsual, Reasonable, & Customary Charge (“U&C”) means: (i) For out-of-network providers, the normal and necessary charges submitted or made for similar services or supplies provided by other providers of medical […]