Pre-Certification/Pre-Certified/Pre-Certify (Medical Necessity Pre-Certification)
Pre-Certification/Pre-Certified/Pre-Certify (Medical Necessity Pre-Certification) refers to obtaining approval from the utilization review manager prior to the date of service for services that have been ordered by a physician or professional […]
Out-of-Network Providers
Out-of-Network Providers refers to physicians and professional providers that are not in-network providers. Except for the following exceptions, services received from out-of-network providers are not covered: Emergency services including emergency […]
Out-of-Network Facilities
Out-of-Network Facilities refers to any health care facility that is not an in-network facility. With the exception of emergency services (including certain post-stabilization care subject to the provisions of the […]
Incorrectly Filed Claim
Incorrectly Filed Claim means any request for Plan benefits that is not made in accordance with the Claims Procedures.
Health Reimbursement Account (HRA)
A tax-free account opened for eligible retirees and/or spouses. The account receives annual contributions from SHARP to reimburse the retiree for qualifying healthcare expenses.
Genetic Information
Genetic Information means information about genes, gene products, and inherited characteristics that may derive from the individual or a family member. This includes information regarding carrier status and information derived […]
Emergency Services
Emergency Services means, as provided in 26 CFR §54.9815-2719AT, or any successor law or regulation, with respect to an emergency medical condition, a medical screening examination which is within the […]
Custodial Care
Custodial Care means care that helps a person conduct such common activities as bathing, eating, dressing or getting in and out of bed. It is care that can be provided […]
Claim
Claim means any request for a Plan benefit or benefits made in accordance with the Claims Procedures. A communication regarding benefits that is not made in accordance with the procedures […]
Adventist Retirement Board
Adventist Retirement Board means the board established by the NAD to maintain and amend from time to time SHARP and the various other NAD programs available to NAD retirees.