Injury is a condition which results independently of sickness and all other causes, and is a result of an externally violent force. Maintenance Care - All services, equipment, and supplies which are provided solely to maintain a patient's condition at the level to which it is restored or stabilized and from which no practical improvement can be expected. The goal is to provide the necessary care in the most cost effective manner possible. It is the responsibility of the Case Manager to ascertain the specific needs of the cases, to assist the patient in obtaining quality services, and to ensure that these services are rendered in the most appropriate and cost effective setting for eligible expenses. The Name of the Plan is the Angleton Independent School District E employee Health Care Plan.
Treatment includes all ancillary services including radiology, pathology and anesthesiology.
Plan is the provisions for coverage and payment of benefits as described herein. Plan Administrator means the Employer, Angleton Independent School District. Pre-Authorization is the process of evaluating the medical necessity of potential cosmetic procedures and determining plan coverage. Pre-Determination is the process of determining the allowable physician fees for surgical procedures covered by the benefit plan. Prior Medical Plan is any plan previously offered by the Employer which was terminated on or prior to the effective date of this Plan.