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') ) 2.36 Medical Services (except as limited or excluded by this Contract) means those professional services of physicians and other Health Professionals, including medical, surgical, diagnostic, therapeutic, and preventive services that are Medically Necessary (except for preventive services as stated herein) for the diagnosis and treatment of injury or illness. 2.37 Medically Necessary means the use of any appropriate medical treatment, service, equipment, and/or supply as provided by a Hospital, skilled nursing facility, physician, or other provider which is necessary for the diagnosis, care, and/or treatment of a Member's illness or injury, and which is: Consistent with the symptom, diagnosis, and treatment of the Member's condition; The most appropriate level of supply and/or service for the diagnosis and treatment of the Member's condition; In accordance with standards of acceptable community practice; Not primarily intended for the personal comfort or convenience of the Member, the Member's family, the physician, or other health care providers; Approved by the appropriate medical body or health care specialty involved as effective, appropriate, and essential for the care and treatment of the Member's condition; and Not experimental or investigational. 2.37.01 2.37.02 2.37.03 0 2.37.04 2.37.05 ) 2.37.06 2.38 Member means any Subscriber or Dependent, as described in Sections 2.53 and 2.18, of this Contract. 2.39 Non-notification Penalty means a defined dollar anlount, as specified in the Schedule of Benefits that may be assessed for failure to obtain prior authorization for certain medical services or medications as defined in Section 2.59, Utilization Management Program, and under 'Prior authorization for covered services' found in the introduction to Part IX, Schednle of Basic Benefits. The penalty does not count towards any deductible or out-of-pocket maximum. 2.40 Non-participating Provider means any Health Professional (or group of Health Professionals), Hospital, Medical Office, or Other Health Care Facility with whom AvMed has neither made arrangements nor contracted to render the professional health services set forth herein as a Participating Provider. The Point of Service Plan provides access to Non-participating Providers as defined herein including providers and facilities under contract by the PHCS Network outside of AvMed's Service Area. 2.41 Other Health Care Facility(ies) means any licenscd facility, other than acutc care Hospitals and those facilities providing services to ventilator dependent patients, which provides inpatient services such as skilled nursing care and rehabilitative services. 2.42 Ont-of.Network Provider means any Health Professional (or group of Health Professionals), Hospital, Medical Office, or Other Health Care Facility who is not under contract with AvMed's Choice Network, and not under contract with the PHCS Network outside of the Service Area. 2.43 Participating Provider means any Health Professional (or group of Health Professionals), Hospital, Medical Office, or Other Health Care Facility within the AvMed Choice Network with whom AvMed has made arrangements or contracted to render the professional health services set fonh herein. 2.44 Participating Physician means any Participating Provider licensed under Chapter 458 (physician), 459 (osteopath), 460 (chiropractor) or 461 (podiatrist), Florida Statutes. 2.45 Post-Service Claim means any Claim for benefits under the Plan that is not a Pre-Service Claim. 2.46 Pre-Service Claim means any Claim for benefits under the Plan with which (in whole or in part) a Member must obtain authorization from AvMed in advance of such services being provided to or received by the Member. A V-CHOICE-2009 MP-5320 (10/09) 6