135 treatment. In determining benefits payable, charges made for the treatment of any physiological conditions related to rehabilitation services for alcohol or drug abuse or addiction will not be considered to be charges for treatment of substance use disorder. Termination includes, with respect to the Continuation of Care benefit, the expiration or nonrenewal of the contract, but does not include a termination of the contract for failure to meet applicable quality standards or for fraud. Total Disability or Totally Disabled means that you or your Spouse are prevented by illness or injury from engaging in any duty of your occupation for wages or profit. For your dependent children, it means they are prevented by illness or injury from engaging in their normal daily activities. Usual, Customary and Reasonable Charges or UC&R Charges (sometimes referred to as Maximum Reimbursable Charge or MRC) means charges for Medically Necessary services or supplies that are determined to be the lowest of: • The 90 th percentile of the usual charge by the health care provider for the same or similar service or supply; • The prevailing charge of most other health care providers in the same or similar geographic area for the same or similar health care service or supply; • With respect to a Preferred Provider, the charge set forth in the agreement between the Preferred Provider and the Preferred Provider Organization or the Plan; or • The health care provider’s actual charge. You and your means the employee/participant who is eligible for coverage under the terms of the plan and who can enroll his or her Spouse and/or eligible dependent children.
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