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<br />ð. /(2-6$ <br /> <br />Definitions <br /> <br />Agreement: Includes the agreement between MHN and the Employer or Group, this Evidence of <br />Coverage and any addenda and/or amendments thereto~ . <br /> <br />Appropriately Qualified Health Care Professional: Is a primary care physician or specialist who is <br />acting within his or her scope of practice and who possesses a clinical background, including training <br />and expertise, related to the particular illness, disease, condition or conditions associated with the <br />request for a second opinion. <br /> <br />Combined Evidence of Coverage & Disclosure Form: A document issued by MHN to a member <br />that describes the specific services covered under the applicable plan. <br /> <br />Emergency medical condition: Means a medical condition manifesting itself by acute symptoms of <br />sufficient severity (including severe pain) such that, the absence of immediate medical attention <br />could reasonably be expected to result in any of the following: <br /> <br />(1) placing the patient's health in serious jeopardy; <br /> <br />(2) serious impaifJ!lent to bodily functions; or <br /> <br />(3) serious dysfunction of any bodily organ or part. <br /> <br />Emergency Services and Care. Means medical screening, examination, and evaluation by a <br />physician, or, to the extent pennitted by applicable law, by other appropriate personnel under the <br />supervision of a physician, to detennine if an emergency medical condition exists and, if it does, the <br />care and treatment necessary to relieve or eliminatê the emergency medical condition. <br /> <br />Employer or Group: An employer, trust fund, licensed health plan or insurer, or other group or <br />business entity that has contracted with MHN for the provision of EAP Services to Members. <br /> <br />Grievance: Any expression of dissatisfaction from a Member, whether received in writing or on the <br />telephone, <br /> <br />:\lember: Any individual who meets all applicable eligibility requirements specified within the <br />Agreement and this Plan, is enrolled under this Plan and for whom all required prepayment fees have <br />been received and accepted by MHN. . <br /> <br />Participating Practitioner: A professional practitioner who furnishes behavioral healthcare services <br />to Members and has agreed, by signing a participating provider agreement with MHN, to accept the <br />provisions of the applicable agreement, including the contractually agreed upon compensation, as the <br />total charge, whether paid fully by MHN or requiring cost sharing by the Member. <br /> <br />Session: Any in-person or telephone consultation with a Participating Practitioner for services <br />covered under this Plan, <br /> <br />12 <br />