104 Covered Medical Charge means a charge that: (1) is made for a medically necessary service or supply that is furnished to a participant; and (2) meets all of the following tests: • It is shown in the covered medical charges l ist or is otherwise listed as a covered medical charge in this SPD . • It is incurred by a participant while the participant is eligible for medical benefits. A charge is deemed to be incurred at the time the service is rendered or the supply is furnished for which the charge is made. • It is not listed as a Plan exclusion. • It does not exceed the smallest of the Covered Charge Limits that apply to the service or supply for which the charge is made. The part of a charge that does not exceed the smallest of the Covered Charge Limits shall be considered a covered medical charge if it meets the above tests. Custodial Care means care that consists of services and supplies that are given mainly to help a person to meet the activities of daily living, whether or not t he person is disabled, and that are not rendered mainly for their therapeutic value in the treatment of an injury or illness. Custodial Care includes, but is not limited to, care such as: • Care mainly to provide room and board; • Preparation of special diets; • Supervision of the administration of medications that can normally be self - administered; and • Personal care such as helping the person to walk, get in or out of bed, bathe, dress, eat, or use the toilet. Deductible means the amount of covered medical charg es a participant must pay to his or her provider of service before benefits are payable by the Plan, as shown in the Schedule of Benefits. Dependent means your Spouse, child under age 26, and your disabled dependent. The term dependent does not include a S pouse who is on active duty in any armed forces. Disability or Disabled means the inability to perform substantially all the duties of the person’s occupation because of a physical or mental illness or injury. For your children, it means they are prevented by illness or injury from engaging in their normal daily activities. Di s abled Dependent means a child, who is incapable of self - sustaining employment because of a physical or mental disability that occurred before the dependent child turned age 26, and wh o is chiefly dependent on you for financial support. Proof of the disability must be submitted before age 26 and may be required periodically thereafter. Durable Medical Equipment means equipment that is: (1) designed for repeated use; (2) mainly and customarily used for medical purposes; (3) not generally of use to a person in the absence of an illness or injury; and (4) not disposable. Durable Medical Equipment includes, but is not limited to, such items as: crutches; Hospital beds; wheelchairs; oxyg en concentrators; CPAP machines; and TENS units. The following items are examples of some, but not all, types of equipment that are not considered to be Durable Medical Equipment: air conditioners; air purifiers; bed and bath items; fixtures to real proper ty; heat lamps; heating pads; bed boards; orthopedic shoes; corrective devices for use in shoes; gravity traction devices; exercise bicycles; weightlifting equipment; and spe cially equipped vans.

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