A sudden, unintentional and unexpected occurrence caused by external, visible means and resulting in physical Injury to the Insured Person. The cause or one of the causes of such Accident is external to the Insured Person's own body and occurs beyond the Insured Person's control.
Death of the Insured Person resulting from an Accident.
Complete severance from the body of one or more Limbs or eyes resulting from an Accident. For purposes of the Accidental Death and Accidental Dismemberment Benefits provided by this insurance, the term “Limb” shall mean: the arm when the severance is at or above (toward the elbow) the wrist, or the leg when the severance is at or above (toward the knee) the ankle. Loss of eye(s) shall include complete, permanent and irrevocable loss of sight.
Act of Terrorism
An act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
Acute Onset of Dental Pain
Sudden and unexpected experience of severe pain in the teeth, gums or bones supporting the teeth.
Acute Onset of Pre-existing Condition
A sudden and unexpected outbreak or recurrence of a Pre-existing Condition which occurs spontaneously and without advance warning in the form of Physician recommendations or symptoms which would have caused a prudent person to seek medical attention prior to the sudden and unexpected outbreak or recurrence, and which requires Emergency treatment by a Physician. Treatment by a Physician must be obtained within the 24 hours beginning on the date and time of the sudden and unexpected outbreak or recurrence.
Acquired Immune Deficiency Syndrome as that term is defined by the United States Centers for Disease Control and Prevention.
A sport or other athletic activity that is organized and/or sanctioned, involving regular or scheduled practices and/or regular or scheduled games. This definition does not include athletic activities that are non-contact and engaged in by an Insured Person solely for recreational, entertainment or fitness purposes and not for wage, reward or profit
The fully answered Application that is completed by or on behalf of the Insured Person, submitted to the Plan Administrator, and maintained on file with the Plan Administrator.
AIDS Related Complex as that term is defined by the United States Centers for Disease Control and Prevention.
The individual Named in the Insured Person's Application to be the recipient of any Accidental Death Benefit. For Insured Persons age 18 and older who do not designate a Beneficiary on the Application, the Beneficiary is automatically as follows: 1. Spouse (if any), 2. Children (if any) equally, 3. Estate of the Insured Person. For Insured Persons who are under age 18 who do not designate a Beneficiary on the Application, the Beneficiary is automatically as follows: 1. Custodial parent(s) (if any), 2. Siblings (if any) equally, 3. Estate of the Insured Person.
The Eligible Expenses which may be paid under the Master Policy.
One hundred eighty (180) consecutive days beginning on the first day of diagnosis or treatment of a covered Injury or Illness that occurs during a during the Certificate Period.
Blackmail and Extortion
The making of illegal threats specifically to an Insured Person to: 1. kill, injure or abduct the Insured Person; or 2. damage property belonging to the Insured Person; or 3. disseminate, divulge or use Trade Secrets belonging to the Insured Person; by persons who then demand a Ransom as a condition of not carrying out such threats.
The summary of the Master Policy, issued to Insured Persons.
The document that is attached to the Certificate issued to Insured Persons.
The period of time beginning on the Effective Date for Insured Person and ending on the Termination Date for Insured Person.
The percentage of Eligible Expenses specified in the Schedule of Benefits and Limits that must be paid by the Insured Person.
A sport or other athletic activity that necessarily involves physical contact with opposing players as part of normal play. Contact Sports include, but are not limited to, American football, boxing, ice hockey, rugby, soccer, and wrestling.
Crisis Coverage Period
Ninety (90) days beginning on the first day of an Insured Event.
Crisis Management Consultant
The independent consultants approved by Underwriters and appointed to assist the Insured Person in connection with an Insured Event.
That type of care or service, wherever furnished and by whatever name called, that is designed primarily to assist an Insured Person in performing the activities of Daily Living. Custodial Care also includes non-acute care for the comatose, semi- comatose, paralyzed or mentally incompetent patients until they are fit to return home.
A twenty-four (24) hour period during which an Insured Person engages in normal daily activities including but not limited to eating, drinking and washing.
The document that is attached to and forms a permanent part of the Master Policy.
The dollar amount of Eligible Expenses, specified in the Master Policy that the Insured Person must pay before Benefits are paid hereunder.
Procedures concerning childbirth.
Treatment and/or supplies relating to the care, maintenance or repair of teeth, gums or bones supporting the teeth, including dentures and preparation for dentures.
The complete and unexpected loss of contact with an Insured Person for a period in excess of forty-eight (48) hours.
Durable Medical Equipment
A standard basic hospital bed and/or a standard basic wheelchair.
Educational or Rehabilitative Care
Care for restoration (by education or training) of one’s ability to function in a normal or near normal manner following an Illness or Injury. This type of care includes, but is not limited to, vocational or occupational therapy and speech therapy.
The date coverage for an Insured Person begins under the terms of the Master Policy.
Expenses for services and supplies which are covered under this insurance.
A medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Insured Person’s life or limb in danger if medical attention is not provided within twenty-four (24) hours based upon reasonable medical certainty.
That part of a Hospital designated for the immediate care of Emergency medical conditions.
Extended Care Facility
An institution, or a distinct part of an institution, which is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the jurisdiction in which it operates; and is regularly engaged in providing twenty-four (24) hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered Nurse; and maintains a daily record on each patient; and provides each patient with a planned program of observation prescribed by a Physician; and provides each patient with active treatment of an Illness or Injury. Extended Care Facility does not include a facility primarily for rest, the aged, Substance Abuse treatment, Custodial Care, nursing care or for care of Mental Health Disorders or the mentally incompetent.
All Relatives of an Insured Person.
The illegal holding under duress, for a period in excess of 6 hours, of an Insured Person whilst travelling on an airplane, vehicle or watercraft during a Certificate Period.
Laboratory evidence defined by the United States Centers for Disease Control and Prevention as being positive for Human Immunodeficiency Virus infection.
The country where the Insured Person principally resides as declared on the Application, except for US citizens and Lawful Permanent Residents of the US. For US citizens, including those with dual citizenship, the US is always your Home Country. For non-US citizens who are Lawful Permanent Residents of the US, the US is always your Home Country.
Home Health Care Agency
A public or private agency or one of its subdivisions, which operates pursuant to law and is regularly engaged in providing Home Nursing Care under the supervision of a Registered Nurse, and maintains a daily record on each patient, and provides each patient with a planned program of observation and treatment by a Physician.
Home Nursing Care
Services provided by a Home Health Care Agency and supervised by a Registered Nurse, which are directed toward the personal care of a patient, provided always that such care is provided in lieu of Medically Necessary Inpatient care in a Hospital.
An institution which operates as a Hospital pursuant to law, and is licensed by the State or County in which it operates; and operates primarily for the reception, care and treatment of sick or injured persons as Inpatients; and provides twenty-four (24) hour nursing service by Registered Nurses on duty or call; and has a staff of one or more Physicians available at all times; and provides organized facilities and equipment for diagnosis and treatment of acute medical conditions on its premises; and is not primarily a rehabilitation facility, long-term care facility, Extended Care Facility, nursing, rest, Custodial Care or convalescent home, a place for the aged, drug addicts, alcoholics or runaways; or similar establishment.
The country being visited by the Insured Person, or where the Insured Person resides temporarily. Host Country does not include the Insured's Home Country .
A sickness, disorder, pathology, abnormality, ailment, disease or any other medical, physical or health condition. Illness does not include learning disabilities, attitudinal disorders or disciplinary problems.
Incidental Trip Home
A period of time not to exceed fourteen (14) days during a
Certificate Period during which an Insured Person is covered for Medical Eligible
Expenses incurred in his or her Home Country. An Incidental Trip Home begins on the
date and time the Insured Person departs his or her Host Country to return to his or her
Home Country, and ends on the next date and time the Insured Person departs his or her
Home Country, subject to a maximum of 14 days. The Incidental Trip Home Benefit is
only available to Insured Person’s with Certificate Periods of ninety (90) days or more
Identifiable physical harm to the body caused by an Accident that requires medical treatment.
A patient who occupies a Hospital bed, excluding Emergency Room beds, for more than twenty-four (24) hours for medical treatment and whose admission was recommended by a Physician.
An individual who meets the Eligibility requirements herein, and has completed the Application and been accepted for coverage hereunder.
Intensive Care Unit
A Cardiac Care Unit or other unit or area of a Hospital that meets the required standards of the Joint Commission on Accreditation of Hospitals for Special Care Units.
Investigational, Experimental or for Research Purposes
Terms used to describe procedures, services or supplies that are by nature or composition, or are used or applied, in a way which deviates from generally accepted standards of current medical practice.
The taking away of a person by force, threat or deceit with intent to cause him or her to be detained against his or her will for Ransom or political purposes. For purposes of this insurance Kidnapping does not include Kidnapping perpetrated by any Relative of the Kidnapped person.
Lawful Permanent Resident of the US, or US Resident
An individual who is not a citizen of the US who is living in the US under legally recognized and lawfully
recorded permanent residence as an immigrant.
Master Policy Period
The period of time beginning on the Effective Date and ending on the Termination Date indicated on the Declaration attached to the Master Policy.
A Hospital, Physician or other person or organization which provides medical services and/or supplies.
A service or supply which is necessary and appropriate for the diagnosis or treatment of an Illness or Injury based on generally accepted current medical practice as determined by Underwriters. A service or supply will not be considered Medically Necessary if it is provided only as a convenience to the Insured Person or Medical Provider, and/or is not appropriate for the Insured Person's diagnosis or symptoms, and/or exceeds in scope, duration or intensity that level of care which is needed to provide safe, adequate and appropriate diagnosis or treatment of an Illness or Injury.
Mental Health Disorder
A mental or emotional disease or disorder which generally denotes a disease of the brain with predominant behavioral symptoms; or a disease of the mind or personality, evidenced by abnormal behavior; or a disorder of conduct evidenced by socially deviant behavior. Mental Health Disorders include but are not limited to: psychosis, those psychiatric Illnesses listed in the current edition of the Diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.
Babies under the age of one month.
An Insured Person who receives Medically Necessary treatment by a Physician for Injury or Illness that does not require overnight stay in a Hospital.
A doctor of Medicine (MD), doctor of Dental Surgery (DDS), doctor of Dental Medicine (DDM), doctor of Podiatry (DPM) or a licensed Physical Therapist or Physiotherapist. Physician also includes a Certified Nurse Practitioner (CNP), a Certified Registered Nurse Anesthetist (CRNA), Nurse Midwife or Physician Assistant (PA) under the direction of a medical doctor. Physician does not include a doctor of Chiropractic (DC), a doctor of Osteopathy (DO), a doctor of Psychology (Ph.D), a doctor of Psychiatry (Psy.D) or any other degree or designation. A Physician must be currently licensed by the jurisdiction in which the services are provided, and the services provided must be within the scope of that license. A Physician must be a person other than the Insured Person, the Insured Person’s Relative, or one who ordinarily resides with the Insured Person.
Transportation of an Insured Person to an alternative country or location which becomes necessary due to Political Threat in the Insured Person’s Host Country.
Political and/or military events which have created a situation in which the Insured Person is in danger of or has incurred serious bodily harm.
Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the two (2) years immediately preceding the Effective Date for Insured Person; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the two (2) years immediately preceding the Effective Date for Insured Person; (3) Injury, Illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of the Insured Person’s Application or within the two (2) years immediately preceding the Effective Date for Insured Person.
Preferred Medical Provider
Medical Providers Medical Providers designated by the Plan Administrator as preferred.
The physical condition of being pregnant.
A group health benefit plan, an individual health benefit plan, or a government plan (Medicaid, Medicare and V.A. health plans are not considered Primary Insurance) designed to be the first payer of claims for an Insured Person, in effect prior to the Certificate Period and in effect at the time of any claim hereunder. Such plans must have coverage limits of $250,000 per incident or per year to be considered Primary Insurance for the purpose of determining the amount of Benefits
available with respect to an Acute Onset of Pre-existing Condition.
The location, indicated on the Insured Person's Application, where the Insured Person ordinarily resides, not including locations in the Host Country.
A sporting activity undertaken for wage, reward or profit.
Proof of Claim
A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments, original itemized bills from Physicians, Hospitals and other Medical Providers, original receipts for any expenses which have already been paid by or on behalf of the Insured Person, and any other documentation that is deemed necessary by the Underwriters.
Money or other valuables, including cash, monetary instruments, bullion, or the fair market value of any securities or property.
A graduate nurse who has been registered or licensed to practice by the local authority Board of Nurse Examiners or any other authority, and who is legally entitled to place the letters “RN” after his or her name.
Biological or stepparent or grandparent; biological or stepchild or grandchild; current spouse; biological or stepsibling; parent, children, or sibling in law; aunt, uncle or cousin; fiancé or betrothed individual.
Routine Physical Exam
Examination of the physical body by a Physician for preventative or informative purposes only, and not for the diagnosis or treatment of any condition.
Sexually Transmitted Diseases
Syphilis, gonorrhea, lymphogranuloma venereum, chancroid, granuloma inguinale, chlamydiosis, pelvic inflammatory disease, trichomoniasis, genital candidiasis, genital herpes, genital warts, amebiasis, viral hepatitis, scabies, crab lice, cervical dysplasia, and bacterial vaginitis.
Alcohol, drug or chemical abuse, overuse or dependency.
Surgery or Surgical Procedure
An invasive diagnostic procedure, or the treatment of Illness or Injury by manual or instrumental operations performed by a Physician while the patient is under general or local anesthesia.
United States or US
The United States of America including all states, districts, territories and possessions.
Usual, Reasonable and Customary
The most common charge for similar services, medicines or supplies within the area in which the charge is incurred, so long as those charges are reasonable. What is defined as Usual, Reasonable and Customary charges will be determined by Underwriters. In determining whether a charge is Usual, Reasonable and Customary, Underwriters may consider one or more of the following factors: the level of skill, extent of training, and experience required to perform the procedure or service; the length of time required to perform the procedure or services as compared to the length of time required to perform other similar services; the severity or nature of the Illness or Injury being treated; the amount charged for the same or comparable services, medicines or supplies in the locality; the amount charged for the same or comparable services, medicines or supplies in other parts of the country; the cost to the Medical Provider of providing the service, medicine or supply; such other factors as Underwriters, in the reasonable exercise of discretion, determine are appropriate.
Any act or threat of violence to an Insured Person which causes, or is likely to cause, death or serious Injury during a Certificate Period.
The involuntary confinement of an Insured Person by any person(s) acting as agents of or with the tacit approval of any government or governmental entity, or acting or purporting to act on behalf of any insurgent party, organization or group.