Across
- 2. Any treatment, procedure, facility, equipment, drug or drug usage that in the opinion of Blue Cross is not medically necessary; lacks sufficient published data; or is not recognized as a standard of care in current prescribing guidelines or practice setting protocols.
- 5. A deterioration of health or a bodily disorder that has been diagnosed by a Physician and requires regular and continuous care.
- 6. A sudden, fortuitous and unforeseeable event.
- 10. A situation that permits a member to change their coverage.
- 11. The management and care of a participant to improve or cure an illness, disorder or injury.
- 12. Participation under this policy is a condition of employment and 100% of eligible employees must apply for coverage.
- 14. The amount of eligible expenses that the participant must pay before Blue Cross will reimburse any eligible expenses.
- 15. An employee who is eligible and approved for coverage under this policy.
Down
- 1. The percentage of the eligible expense Blue Cross will pay for Health Benefits as specified in the Summary of Benefits.
- 3. Statements or medical evidence about a Participant’s health, as needed and requested by Blue Cross at any time and must be submitted on forms approved by Blue Cross for that purpose.
- 4. The employer or group that is specified on the group coverage policy page.
- 6. A provider of health care services or supplies who has been approved by Blue Cross to provide specific eligible expenses.
- 7. Essential work-related activities that are performed by the Member.
- 8. The spouse or child of a member.
- 9. A person who works for the employer the minimum number of hours per week specified in the summary of benefits and is a resident of Canada.
- 13. Canadian Life and Health Insurance Association Inc.