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) Service Area means those counties in the State of Florida where AvMed has been approved to conduct business by the Agency for Health Care Administration (AHCA). 3.46 Specialty Health Care Physician means any Participating Physician licensed under Chapter 458 (physician), 459 (osteopath), 460 (chiropractor) or 461 (podiatrist), Florida Statutes, other than the Member's chosen Primary Care Physician. 3.45 ') 3.47 Subscriber means a person who meets aU applicable requirements of Section 4.01, enrolls in the Plan, and for whom the premium prepayrnent required by Part VII has actually been received by AvMed. 3.48 Subscribing Group means a corporation, partnership, limited liability company or other legal entity (and its wholly-owned subsidiaries) that negotiates and agrees to contract for the health services and benefits provided herein for its eligible employees. Total Disability means a totally disabling condition resulting from an illness or injury which prevents the Memher from engaging in any ernployment or occupation for which he rnay otherwise become qualified by reason of education, training, or experience, and for which the Member is under the regular care of a physician. 3.50 Urgent Care Claim means any Claim for rnedical care or treatment that could seriously jeopardize the Member's life or health or the Member's ability to regain maximum function or, in the opinion of a physician with knowledge of the Member's medical condition, would subject the Member to severe pain that cannot be adequately rnanaged without the care or treatment requested. Generally, the determination of whether a Claim is an Urgent Care Claim shaU be rnade by an individual acting on behalf of AvMed applying the judgrnent of a prudent layperson who possesses an average knowledge of health and medicine. However, if a physician with knowledge of the Mernber's medical condition determines that the Claim is an Urgent Care Claim, it shall be deemed as such. 3.49 l) Urgent CarelImmediate Care means medical screening, examination, and evaluation received in an Urgent Care Center or lmmediate Care Center or rendered in your Primary Care Physician's office after- hours and the covered services for those conditions which, although not life-threatening, could result in serious injury or disability ifleft untreated. 3.52 Utilization Management Program means those comprehensive initiatives that are designed to validate medical appropriateness and to coordinate covered services and supplies. These include, but are not lirnited to: 3.51 ) 3.52.01 Concurrent review of all patients hospitalized in acute care, psychiatric, rehabilitation, and skilled nursing facilities, including on-site review when appropriate; 3.52.02 Case management and discharge planning for all inpatients and those requiring continued care in an alternative setting (such as home care or a skilled nursing facility) and for outpatients when deerned appropriate; and 3.52.03 The Benefit Coordination Program which is designed to conduct .prospective reviews for select medical services to ensure that services are covered and Medically Necessary. The Benefit Coordination Program rnay also advocate altemative cost-effective settings for the delivery ofpre,cribed care and rnay identifY other options for non-covered health care needs. 3.53 Ventilator Dependent Care Unit rneans care received in any facility which provides services to ventilator dependent patients other than acute Hospital care, including all types of facilities known as sub-acute care units, ventilator dependent units, alternative care units, sub-acute care centers, and all other like facilities whether maintained in a free standing facility or maintained in a Hospital or skilled nursing facility setting. 7 AV-OIOO-2009 MP-5319 (10/09)