100 Glossary Accident means an unexpected and unintentional event occurrin g through external means, not necessarily involving another person. Injuries caused by normal activities of daily living (such as walking, bending, stretching, etc.) are not considered to be accidents. Acute Care Hospital or Hospital means only an institut ion that meets all of the following tests: • It mainly provides medical treatment to inpatients. • It maintains facilities for diagnosis. • It pr ovides treatment only by or under a staff of physicians. • It provides care by Registered Nurses 24 hours per day. • It m aintains permanent facilities for surgery. • It maintains a daily medical record for each patient. • It complies with all licensing and other legal requirements. • It is not a Skilled Nursing Facility or a Specialized Facility. • It is not, other than incidentally , (1) a place for Custodial Care; (2) a place for the aged; (3) a place for the care of a person addicted to or dependent on a drug or chemical including alcohol; (4) a place for the care of persons with mental, nervous, or emotional disorders or condition s; (5) a place of rest; or (6) a nursing home, hotel, or a similar institution. Allied Health Professional means a health care provider who is licensed and practicing within the scope of his or her license. Ambulatory Surgical Facility means a facility t hat meets Professionally Recognized Standards and all of the following tests: • It provides a setting for outpatient surgeries. • It does not provide services or accommodations for overnight stays. • It has at least two operating rooms and one recovery room; all the medical equipment needed to support the surgery performed; x - ray and laboratory diagnostic facilities; and Emergency equipment, trays, and supplies for use in life threatening events. • It has a medical staff that is supervised full time by a physician and that includes a registered Nurse at all times when patients are in the facility. • It maintains a medical record for each patient. • It has a written agreement with a local Acute Care Hospital and a local ambulance company for the immediate transfer of pat ients who require greater care than can be furnished at the facility. • It complies with all licensing and other legal requirements. • It is not the office or clinic of one or more physicians. For purposes of determining a medical benefit, a surgical procedure performed in an Ambulatory Surgical Facility that, as determined by the Claims Administrator, is commonly performed in a physician’s office shall be deemed to have been performed in a physician’s office.

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