130 9. Within the capabilities of the staff and facilities available at the hospital or the independent freestanding emergency department, as applicable, such further medical examination and treatment as are required to stabilize the patient (regardless of the department of the hospital in which such further examination or treatment is furnished). Emergency Services furnished by a Non-PPO Provider or Non-PPO emergency facility (regardless of the department of the hospital in which such items or services are furnished) also include post- stabilization services (services after the patient is stabilized) and as part of outpatient observation or an inpatient or outpatient stay related to the emergency medical condition, until: • • The provider or facility determines that the participant or beneficiary can travel using non-medical transportation or non-emergency medical transportation; or • • The participant or beneficiary is supplied with a written notice, as required by federal law, that the provider is a Non-PPO Provider with respect to the Plan, of the estimated charges for your treatment and any advance limitations that the Plan may put on your treatment, of the names of any PPO Providers at the facility who are able to treat you, and that you may elect to be referred to one of the PPO Providers listed; and • • The participant or beneficiary gives informed consent to continued treatment by the Non-PPO Provider, acknowledging that the participant or beneficiary understands that continued treatment by the Non-PPO Provider may result in greater cost to the participant or beneficiary. 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 an Employee under 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 Security Act of 1974, as amended. Extended Care Facility means an institution that is approved as such under Medicare. Health Care Facility (for Non-Emergency Services) is each of the following: 10. A hospital (as defined in section 1861(e) of the Social Security Act); 6 11. A hospital outpatient department; 12. A critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act); and 13. An ambulatory surgical center described in section 1833(i)(1)(A) of the Social Security Act. 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 Home Health Agency under Medicare. Hospice Care is care that: • Is furnished or arranged by a Hospice Care Program;
BTF Summary Plan A/A+ Page 134 Page 136