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Diagnostic and statistical Manual of Mental Disorders, Third Edition, Revised ("DSM") : A listing of diagnostic categories and criteria which provides guidelines for making diagnoses of mental and substance abuse disorders. The DSM is a widely accepted basis for describing the presence and type of these disorders. A DSM diagnosis of mental or substance abuse disorder is a minimum requirement for the demonstration of Medical/Psychological Necessity. The diagnosis must be contained in the most recent edition of the DSM.' Dependent: Those individuals in a Subscriber's Family unit who meet the criteria of the definition of dependent as used in the Internal Revenue Code and Regulations of the United states, subject to any Employer prerequisites to the contrary described in the Group Agreement. Employee: An individual whose employment or affiliation status with Employer meets the eligibility prerequisites set forth in the Group Agreement. Family Member: Any individual of a Subscriber's Family Unit who meets all applicable eligibility requirements and Employer prerequisites specified within the Group Agreement. Family unit: A unit comprised of a Subscriber and each person whose eligibility for Covered Services is based upon such person's relationship with, or dependency upon, such Subscriber. Medically/Psychologically Necessary: Covered Services which are necessary and appropriate for treatment of a Member's symptoms and behaviors that demonstrate the presence of a mental or substance abuse disorder as described in the DSM. The terms "necessary" and "appropriate" as used in this paragraph are determined according to professionally recognized standards of practice. Attending Participating Providers are exclusively responsible for making all medical determinations and treatment decisions. However, payment for Covered Services rendered will be conditioned on OHS' subsequent review and determination as to consistency with these standards and OHS' medical policies. The fact that a Participating Provider may prescribe, order, recommend or approve a service, supply or admission does not, in itself, make it Medically/Psychologically Necessary or make the charge an allowable Covered Service even though it is not specifically listed as an exclusion or limitation. Member: An Employee, Dependent, Subscriber or Family Member who meets all applicable eligibility requirements specified within the Agreement, is enrolled under this plan and for whom the required prepayment fees have been received and accepted by OHS. Participating Provider: A physician, psychiatrist, psychologist, - 17 - .,"" ,