Allergy/Asthma/Immunology. The diagnosis and treatment of allergic conditions, asthma, and diseases of the immune system in children and adults.

Anesthesiology. Administration of anesthesia and nerve blocks.

Audiology. the study and testing of hearing levels done by a specialist.

Benefit Review Committee. The term "Benefit Review Committee" or "BRC" means the governing body that oversees the operation of the Plan according to the Trust Agreement and Declaration of Trust. Its members are appointed by the ECOH.

Benefit Year. The term "Benefit Year" means a period of twelve consecutive months beginning each January and running through the following December. The terms Benefit Year and Year are used interchangeably in this Plan.

Cardiology. A branch of Internal Medicine dealing with the diagnosis and treatment of the heart and blood vessels.

Case Management. The coordination and integration of health services for patients with complex or extra ordinary costly medical problems, such as acquired immune deficiency syndrome, spinal cord injury, or premature birth. Case managers, typically registered nurses or clinical social workers, strive to ensure that patients have timely access to high quality, coordinated, cost-effective medical care.

Centers of Excellence. Through outcome and patient satisfaction measurements, ECOH is beginning the process of providing the very best quality physicians for the network. This is the first step in maintaining the highest quality for member companies' employees and family members.

Chiropractic. Treatment of disorders considered to be caused by neural malfunction through manipulation of the spinal column and other structures.

COBRA. The term "COBRA" refers to the Consolidated Omnibus Budget. Reconciliation Act of 1985, as amended, which provides for continuation coverage for qualified beneficiaries.

Co-insurance. Provisions in managed health care member coverage that limits the plan's coverage to a certain percentage of the cost of services (often 80%); the member pays the remainder. This requires the member to have some financial responsibility, again often 20%.

Deductible. Portion of health care expenses that a plan member must pay before insurance coverage applies.

ECOH Medical Director. A physician identified by ECOH to assist in the clinical development and implementation of the Plan.

Emergency Medicine. Branch of medicine dealing with medical and surgical emergencies, usually in a hospital emergency room. Also see Immediate/Urgent care.

Employer. The term "Employer" means each employer which is a member of ECOH and which has, or may hereafter, adopt the Plan with respect to its employees.

Endocrinology. A branch of Internal Medicine dealing with diseases of the thyroid, parathyroid, pituitary, adrenals, pancreas, ovaries and testes.

ERISA. The term "ERISA" refers to the Employee Retirement Income Security Act of 1974, as amended.

Family Practitioner. Specialty trained physicians who provide general medicine care to all age groups. Services include internal medicine, pediatrics and some surgery.

Gastroenterology. A branch of Internal Medicine that provides treatment of diseased and functions of the esophagus, stomach and intestines.

General Practitioner. Physicians who provide general medicine care to all age groups as in family practice.

Genetics. The study of heredity as it relates to disease processes.

Gynecology. Medical and surgical treatment of female reproductive organs.

Health Appraisal. An assessment of the Participant's health status.

Hematology/Oncology. A branch of Internal Medicine dealing with the treatment of diseases and disorder of the blood and blood forming tissues, and the diagnosis and treatment of tumors and cancer.

Home Infusion. Administration of intravenous fluids and medication to patients in the home setting.

Home Health Care. Medical care provided in a patient's home that often replaces more costly care in other settings, such as Long Term Care facilities or hospitals.

Hospital. The term "Hospital" means a licensed accredited general hospital, which has full diagnostic, surgical and therapeutic facilities under the supervision of a staff of licensed physicians, and regularly provides 24 hour nursing service by registered nurses or licensed practical nurses. Institutions maintained for care of the aged, rest or nursing homes, or other extended care facilities are not considered Hospitals within the meaning of the Plan.

Illness. The term "Illness" means a bodily disorder, disease, physical sickness, mental infirmity, or functional disorder of covered person, which does not arise, and which is not caused or contributed to by, or as a consequence of, any employment or occupation for compensation or profit. Related concurrent illness will be considered as a single illness.

Immediate Urgent Care. A less costly alternative to a hospital emergency care facility.

Infertility. Branch of medicine which determines cause and treatment of the inability to conceive.

Injury. The term "injury" means a condition caused by accidental means which results in damage to the covered person's body from an external force, but which does not arise, and which is not caused or contributed to by, or as a consequence of, any employment or occupation for compensation or profit.

Internal Medicine. Diagnosis and non-surgical treatment of diseases and disorders of adults.

Long-term Care. Health care for patients with chronic disabilities or who suffer from serious cognitive impairment and require assistance with the routine activities of daily living: types include: residential, intermediate, subacute, and elder care.

Mammography. X-rays of the breast to identify abnormalities.

Medically Necessary. The term "Medically Necessary" means health care services, supplies or treatment which, in the judgment of the care manager, are appropriate and consistent with the diagnosis and which, in accordance with generally accepted medical standards, could not have been omitted without adversely affecting the patient's condition or the quality of medical care rendered

Neonatology. Treatment and care of premature and/or high-risk newborn babies.

Nephrology. A branch of Internal Medicine dealing with the diagnosis and treatment of disorders of the kidneys.

Neurosurgery. Diagnosis and surgery of the nervous system, including the brain.

Neurology. Diagnosis and medical treatment of the nervous system, including the brain.

Obstetrics (OB). Management and care of pregnancy and childbirth.

Occupational Illness or Injury. The term "Occupational Illness or Injury" means an on- the-job illness or injury which occurs in the course and scope of employment, in furtherance of the business of the employer, or is caused or aggravated thereby. Benefits for Occupational Illness or injury are sometimes referred to herein as workers' compensation benefits.

Oncology. Diagnosis and treatment of tumors and cancer.

Open Enrollment Period. Designated period, perhaps 1 or 2 months a year, during which a health plan's current members may switch health plans and non-members may apply for membership.

Ophthalmology. Medical and surgical treatment of diseases and disorders of the eye, including and evaluation of vision and prescription of lenses for visual problems.

Orthopedics. Surgical and medical treatment of ligaments, joints, muscles, tendons and related structures.

Otolaryngology. Medical and surgical treatment of the head and neck, including ears, nose and throat.

Outpatient Facility. A medical facility outside of a hospital setting, or at a hospital if room and board charges are not incurred.

Participant. The term "Participant" means each person who is or may be entitled to receive benefits under this Plan and who is in the employ of an Employer which has adopted the Plan with respect to its employees, or is a dependent of such person.

Pathology. Laboratory study of body tissue and fluids to diagnose disease.

Pediatrics. Non-surgical treatment of disease and disorders of children.

Pediatric Oncology. Diagnosis and treatment of diseases and disorders of the blood, cancer, hematology and tumors in children.

PHO. Physician Hospital Organization.

Physician. A person acting within the scope of his/her license and holding the degree of Doctor of Medicine (M.D.), Doctor of Osteopathy D.O.), Doctor of Dental Surgery D.D. S.), Doctor of Dental Medicine (D.M.D.), or Doctor of Podiatry Medicine D.P.M.), or Doctor of Chiropractic (D.C.), and who is legally entitled to practice medicine in all its branches under the laws of the state of Illinois.

Physical Medicine & Rehabilitation. the practice of physical therapy and other restorative therapies performed by a specialist.

Plan. The term "Plan" means the Employers' Coalition on Health Employee Benefit Trust Employee Welfare Benefit Plan as set forth in this document, together with all amendments or modifications made to it.

Plan Administrator. The term "Plan Administrator" means the Employers' Coalition On Health or, here designated, appointed and employed the by the BRC, in writing, an agent, whether a legal entity or a person, who shall, prior to said designation, appointment and employment, acknowledge in writing such agent's fiduciary status with respect to the Plan and shall accept the position of Plan Administrator.

Podiatry. Diagnosis and treatment of disorders of the foot and ankle.

PPO. Preferred Provider Organization. A managed health plan that uses its provider network to render care to patients who have signed up with the network. The network usually is limited in size. Providers are paid discounted fees.

Preferred Provider(s) are those entities, institutions, or physicians identified by ECOH to deliver services to its Participants.

Primary Care Physician (PCP). A physician practicing family medicine, general practice, internal medicine or pediatrics.

Primary Health Care Services. Those benefits set forth in Article II of this Plan "Schedule of Primary Health Care Services."

Psychiatry. Diagnosis and treatment of mental and emotional conditions by a Doctor of Medicine.

Pulmonology. A branch of Internal Medicine that deals with the diseases of the respiratory system.

Radiology. Use of X-rays and radioactive materials to diagnose disease and injury.

Radiation Oncology/Therapy. The treatment of certain tumors and disorders with radiation therapy.

Rheumatology. A branch of Internal Medicine for the medical diagnosis and treatment of arthritis and rheumatic disorders.

Surgery/Cardiovascular. Surgical treatment of diseases and disorders of the heart and blood vessels.

Surgery/Colon and Rectal. Diagnosis and treatment of diseases or disorders of the lower digestive tract, rectum and anus.

Surgery/General. Diagnosis and treatment of disease and injury.

Surgery/Hand. Diagnosis and surgical treatment of disease and disorders of the hand.

Surgery/Maxillofacial. Surgical treatment of face, teeth and jaw disorders.

Surgical/Neurological. Surgical treatment of disease and disorders of the brain and nervous system.

Surgery/Oral (Teeth). Surgical treatment of diseases, disorders and injuries of the oral cavity.

Surgery/Orthopedic. Diagnosis and surgical treatment of diseases, disorders and injuries of the bones, joints, muscles and tendons.

Surgery/Plastic and Reconstructive. Surgical treatment of restoration of function or for cosmetic purposes.

Surgery/Thoracic. Surgery of diseases of the chest cavity (excluding heart).

Surgery/Vascular. Diagnosis and surgery of blood vessels.

Trust. The term "Trust" means the trust established by the ECOH pursuant to the Plan, and any other trust or fund established hereunder, as well as any modification, amendment, extension or renewal thereof.

Urology. Diagnosis and medical or surgical treatment of diseases and disorders of the genitourinary tract.

Usual, Customary, and Reasonable Charge (UCR). Commonly charged or prevailing fees for health services within a geographic area.

Utilization Review. Tool of utilization management in which health care plans review services delivered by providers to control the use of costly medical interventions.