103 Emergency means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an avera ge knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopard y; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. Emergency Services include medical screening examinations within the capability of the emergency department of a hospital, including ancillary services routinel y available to the emergency department to evaluate such emergency medical condition, and other further medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available at the hosp ital to stabilize the patient. Employee means a person who is actively working for an Employer in a covered position and on whose behalf the Employer makes the required contributions to Plan. An unincorporated sole proprietor or partner in a partnership cannot be treated as a n Employee und er the Plan. Employer means any Employer obligated under a collective bargaining agreement or other signed agreement to make contributions to the Plan on its Employees’ behalf. ERISA means the Employee Retirement Income Se curity Act of 1974 , as amended. Extended Care Facility means an institution that is a pproved as such under Medicare. Home Health Care is medical care that is furnished by or through a Home Health Agency to a participant in the participant’ s home. Home Health Agency means an agency that provides Home Health Care services that (1) meets any legal licensing required by the state or other locality in which it is located; or (2) qualifies as a participating Hom e Health Agency under Medicare. Hospice Care is care that: • Is furnish ed or arranged by a Hospice Care Program; • Is provided as part of a coordinated plan of home and inpatient care designed to meet the special needs of the terminally ill patient and the family unit due to the terminal illness; • May include medical care, pal liative care, respite care, and medical social services for the terminally ill patient; and • May include medical social services and bereavement counseling for the family unit. Hospice Care Program means an agency, facility, or organization that provides care for terminally ill patients and meets established standards, including certification by the National Hospice Organization, Medicare, and any legal licensing required by the state or other local ity in which it is located. Illness means a disease or disorder res ulting in an unsound condition of the mind or body. Injury means a wound or damage to the body sustained by accident or through external force. Inpatient and Outpatient refer either to the setting in which medical care is given or to a person who is receiving care in that se tting. • When these terms describe the setting in which medical care is given: ‒ Inpatient means that the care is furnished to a person while the person is confined in a faci lity as a registered bed patient and is being charged a fee for inpatient room and board; and ‒ Outpatient means that the care is furnished to a person while the person is not so confined.
2018 BTF Plan C Page 107 Page 109