Click here to login to PCYOU

PCYOU

Login to access member resources.

Forgot password?

Not a member? Sign up here.

Close

Glossary

A
Accident; Accidental

A sudden, unintentional and unexpected occurrence directly caused by external, visible means and resulting in physical Injury to the Insured Person. The cause or one of the causes of such Accident must be external to the Insured Person’s own body and must occur beyond the Insured Person’s control.

Accidental Death

Death of the Insured Person resulting from an Accident.

Accidental Dismemberment

Complete severance from the body of one or more limbs or eyes resulting from an Accident. For purposes of the 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 without limitation, 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

Actual Cash Value

The replacement cost of an item, less proper deduction for depreciation at the time of the loss.

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: (1) spontaneously and without advance warning in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires immediate Emergency medical care; and (2) after the Certificate Effective Date; and (3) prior to the age indicated in the Schedule of Benefits and Limits contained herein. Treatment by a Physician must be obtained within the twenty-four (24) hours beginning on the date and at the time of the sudden and unexpected outbreak or recurrence.

Adventure Sport(s)

A sporting activity undertaken for the purposes of recreation or an unusual experience or excitement, typically performed outdoors, and involving a medium degree of risk, including only the following: Absailing BMX Bob-sledding Bungee jumping Canyoning Caving Hot air ballooning Kitesurfing and Kiteboarding Mountaineering below 4,500 meters from ground level Zip lining Parachuting Paragliding Parascending Rappelling Scuba diving or sub-aqua pursuits to a depth of more than 10 meters and less than depth of 20 meters, provided the Insured Person has the experience, training and proper certification by a recognized certifying agency and is accompanied by a qualified instructor Skydiving Spelunking Whitewater kayaking or whitewater rafting in water less than Class V difficulty Wildlife Safaris Windsurfing

AIDS

Acquired Immune Deficiency Syndrome as that term is defined by the United States Centers for Disease Control and Prevention

Amateur Athletics

A sport or other non-professional sporting, recreational or athletic activity that is organized and/or sponsored and/or sanctioned, and/or involves regular or scheduled practices, games and/or competitions. Amateur Athletics includes, without limitation, intercollegiate, interscholastic and intramural sports. Amateur Athletics does not include sports or athletic activities that are non-organized, non-contact and engaged in by the Insured Person solely for recreational, entertainment or fitness purposes and not for wage, reward or profit.

Ancillary Services

All Hospital services for a patient other than room and board and professional services. Laboratory tests and radiology are examples of Ancillary Services.

Application

The fully answered and signed (including electronic signatures) form that is submitted by or on behalf of the Insured Person for acceptance into the insurance provided under the Master Policy. Any insurance agent/broker or other person or entity assigned to, soliciting, or assisting with the Application is the agent and representative of the applicant/Insured Person and is not and shall not be deemed or considered as an agent or representative for or on behalf of Underwriters or the Plan Administrator.

ARC

AIDS Related Complex as that term is defined by the United States Centers for Disease Control and Prevention.

Assured

The organization indicated on the Master Policy Declaration.

B
Beneficiary

The individual named in the Insured Person’s Application to be the recipient of any Accidental Death or Common Carrier 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 eighteen (18) who do not designate a Beneficiary on their Application, the Beneficiary is automatically as follows: 1) Custodial parent(s) (if any), 2) Siblings (if any) equally, 3) Estate of the Insured Person.

Benefit Period

The period of time, specified in the Schedule of Benefits and Limits, that begins on the first day of treatment by a Physician of a covered Injury or Illness while the Insured Person is outside his or her Home Country.

Benefits

The Eligible Expenses or part thereof, which may be paid under this Master Policy.

C
Certificate

The document, including the Certificate Declaration, which is issued to Insured Persons and is a summary of this Master Policy and evidence of the Insured Person’s coverage hereunder.

Certificate Declaration

The document that is attached to the Certificate issued to Insured Persons.

Certificate Effective Date

The date and time coverage under this insurance begins with respect to an Insured Person.

Certificate Period

The period of time beginning on the Certificate Effective Date and ending on the Certificate Termination Date.

Certificate Termination Date

The date and time coverage under this insurance ends with respect to an Insured Person.

Co-pay

The payment by or obligation of the Insured Person for payment for covered services specified in the Schedule of Benefits and Limits. The Co-pay is applied each time the Insured Person receives the specified service. The Co-pay does not apply toward satisfaction of the Deductible or Coinsurance.

Coinsurance

The payment by or obligation of the Insured Person for payment of covered expenses at the percentage specified in the Schedule of Benefits and Limits.

Common Carrier

A company or organization that holds itself out to the public as engaging in the business of transporting persons from place to place by air, rail, bus and/or water for compensation, offering its scheduled services to the public generally, and is licensed by a recognized and approved government authority to transport fare-paying passengers. The term Common Carrier does not include taxi, motorcar, motorcycle or limousine services, or transportation by animal or human means (for example, horse, camel, elephant or riskshaw).

Congenital Disorder(s)

A physical abnormality, defect or medical condition existing at or before birth, regardless of cause or when diagnosed or treated.

Contact Sport(s)

A sport in which the participants purposely hit or collide with each other, inanimate objects, the ground or water, with force, including without limitation: American football Basketball High diving and cliff diving Fighting or combat sports, including without limitation, boxing, wrestling, martial arts, mixed martial arts, fencing and kickboxing Hockey, including ice and field hockey Lacrosse Polo Rodeo Rugby Ski jumping Soccer

Covered Electronics and Communication Equipment

The following items exclusively: mobile telephones, tablets and laptop computers.

Covered Personal Equipment

Covered Sports Equipment, Covered Photography Equipment and Covered Electronics and Communication Equipment exclusively.

Covered Photography Equipment

The following items exclusively: cameras, camera flash accessories and camera lenses.

Covered Scuba Equipment

The following items exclusively: Scuba tank, regulator, analog or digital depth gauge, submersible pressure gauge, dive computer, buoyancy compensator, underwater camera.

Covered Sports Equipment

The following items exclusively: skis, ski boots, ski poles, snowboards, snowboard boots, golf clubs, golf bags, tennis rackets.

Covered Water Sports

The following activities exclusively: Kitesurfing and Kiteboarding Windsurfing Scuba diving or sub-aqua pursuits to any depth for which the Insured Person has the experience, training and proper certification by a recognized certifying agency Operating or riding as a passenger on board a Personal Watercraft

Custodial Care

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.

D
Daily Living

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.

Declaration

The document that is attached to and forms a permanent part of this Master Policy.

Deductible

The dollar amount of Eligible Medical Expenses, specified in the Master Policy, which the Insured Person must pay before receiving benefits or coverage hereunder, not including any applicable Co-pays or Coinsurance.

Delivery

Procedures concerning childbirth.

Dental Treatment

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.

Dependent

Dependent Spouse and Dependent Child(ren).

Dependent Child(ren)

A biological child, legally adopted child or step child who is unmarried, resides with the primary Insured Person and has resided with the primary Insured Person for at least 6 consecutive months immediately preceding the Certificate Effective Date.

Domestic Cat(s)

A member of the species felis catus, which is ordinarily kept as an indoor pet.

Domestic Dog(s)

A member of the species canus lupus familiarus, which is ordinarily kept as an indoor pet.

Durable Medical Equipment

Exclusively a standard basic hospital bed and/or a standard basic wheelchair.

E
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.

Effective Date

The date coverage for an Insured Person begins under the terms of the Certificate.

Eligible Medical Expenses

Expenses for services and supplies for treatment of Injury or Illness which are covered under this insurance.

Eligible Transportation Expenses:

Expenses for transportation and accommodation which are covered under this insurance.

Emergency

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. Immediate medical intervention and attention is required as a result of a severe, life threatening or potentially disabling condition.

Emergency Kennel

A licensed, formal establishment which operates as a boarding kennel where the Insured Person’s pet is housed temporarily, following the Insured Person’s Hospitalization for a covered Injury or Illness and who charges boarding fees.

Emergency Room

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.

Extreme Sport(s)

A sporting activity, including practice, preparation and actual sporting events, which involves a high degree of risk. These activities often involve speed, height, a high level of physical exertion and/or highly specialized gear, and often carry the potential risk of serious or permanent physical Injury and even death. These activities include, without limitation, the following and any combination or derivative of the following: Back country snow skiing, snowboarding or snowmobiling Base jumping Cave diving Downhill mountain biking Extreme Skiing Free diving Free flying Free running and Parkour Free skiing Freestyle scootering Gliding Heli-skiing Ice canoeing Ice climbing Jet skiing Racing any vehicle or animal, including mountain bikes, motocross, motorcycle racing, motor rally, snowmobile racing, truck racing, horse racing, boat racing Mountaineering above elevation of 4,500 meters from ground level Piloting a commercial or non-commercial aircraft Powerboking Competitive Skateboarding Snow skiing, snowboarding or snowmobiling off piste Scuba diving or sub-aqua pursuits below a depth of 50 meters Whitewater kayaking or whitewater rafting Class V or higher difficulty (Class V = A section of a river, stream or other waterway or watercourse where the current moves with enough speed or force to meet, but not to exceed, the qualifications of Class V as determined by the International Scale of River Difficulty or as commonly published by a local authority or government agency.) Wingsuit flying

F
Family

All Relatives of an Insured Person.

Full-time Student

A person who is enrolled in a program that leads to a degree, certificate or other recognized educational credential and regularly attends an Educational Institution for the minimum number of credit hours required by the Educational Institution in order to maintain a full-time student status. On-the-job training courses, correspondence schools, and schools offering courses only through the internet do not qualify as Educational Institutions, Full-time Scholar: A graduate student, teacher, researcher, or professor who is affiliated with an Educational Institution and is engaging in educational activities for at least thirty (30) hours per week. On-the-job training courses, correspondence schools, or schools offering courses only through the internet do not qualify as Educational Institutions.

H
HIV+

Laboratory evidence defined by the United States Centers for Disease Control and Prevention as being positive for Human Immunodeficiency Virus infection.

Home Country

The country where the Insured Person principally resides as declared on the Insured Person’s 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 prescribed 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.

Hospice

An institution which operates as a Hospice, is licensed by the state or country in which it operates; and operates primarily for the reception, care and palliative control of pain for terminally ill persons who have, as certified by a Physician, a life expectancy of not more than six (6) months.

Hospital

An institution which operates as a Hospital pursuant to law, and is licensed by the state or Country 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 or abusers, alcoholics or runaways; or similar establishment.

Hospitalized; Hospitalization

Confined and/or treated in a Hospital as an Inpatient.

Host Country

The country being visited by the Insured Person, or where the Insured Person resides temporarily. Host Country does not include the Insured Person’s Home Country.

I
Illness

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 during which an Insured Person is covered for certain Eligible Medical Expenses incurred in his/her Home Country with respect to new Injuries or Illnesses. An Incidental Trip Home begins on the date and time the Insured Person first departs his/her Host Country to return to his/her Home Country, not including the Insured Person’s final return trip to his/her Home Country. An Incidental Trip Home ends on the next date and time the Insured Person departs his/her Home Country to return to the Host Country.

Injury

Identifiable physical harm to the body caused by an Accident that requires medical treatment.

Inpatient

A patient who occupies a Hospital bed for more than twenty-four (24) hours, not including time spent in an Emergency Room, for medical treatment and whose admission was recommended by a Physician.

Installment Due Dates

Thedates indicated on the Certificate Declaration when Premium Installments are due.

Insured Person

An individual who meets the Eligibility requirements herein, and has completed the Application and been accepted for coverage hereunder.

Insured Person’s Application; Application

The fully answered and signed (including electronic signatures) form that is submitted by or on behalf of the Insured Person for acceptance into the insurance provided under this Master Policy, submitted to the Plan Administrator and maintained on file with the Plan Administrator. Any insurance agent/broker or other person or entity assigned to, soliciting, or assisting with the Application is the agent and representative of the applicant/Insured Person and is not and shall not be deemed or considered as an agent or representative for or on behalf of Underwriters or the Plan Administrator.

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 Healthcare Organizations for Special Care Units.

Interfacility Ambulance Transfer

Movement of the patient locally from one licensed health care facility to another licensed health care facility via air or land ambulance.

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.

L
Lawful Permanent Resident(s) of the US; US Resident(s)

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.

Local Ambulance

Transportation and accompanying treatment provided by licensed, qualified professional emergency personnel from the location of a covered Accident, Injury or acute Illness to a Hospital or other appropriate health care facility within a 50 mile radius of the location of the Insured Person.

M
Master Policy Declaration

The document that is attached to and forms a permanent part of this Master Policy.

Master Policy Period

The period of time beginning on the Effective Date and ending on the Termination Date indicated on the Master Policy Declaration attached hereto.

Medical Provider(s)

A Hospital, Physician or other person or organization which provides medical services and/or supplies.

Medically Necessary or Medical Necessity

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(s)

A mental, nervous or emotional disease or disorder that 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, those psychiatric Illnesses listed in the current edition of the International Classification of Diseases as published by the US Department of Health and Human Services and those psychiatric and other mental Illnesses listed in the current edition of the Diagnostic and Statistical Manual for Mental Disorders of the American Psychiatric Association.

N
Natural Disaster

Widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm or other storm, landslide or other natural catastrophe or event resulting in immigration of human population for its safety. The occurrence must be a disaster that is due entirely to forces of nature and could not reasonably have been prevented.

Newborn(s)

Babies under the age of thirty-one (31) days.

O
Outpatient

An Insured Person who receives Medically Necessary treatment by a Physician for Injury or Illness who is not admitted as an Inpatient, regardless of the hour the Insured Person arrived to the Hospital, whether a bed was used or whether the Insured Person remained in the Hospital past midnight.

P
Personal Watercraft; PWC:

A motorized watercraft that the rider sits or stands on, rather than inside of, like a boat, and is 13 feet (4 meters) or less in length. PWCs are often referred to by their trademarked brand names such as Jet Ski, WaveRunner or Sea-doo.

Physician

A doctor of Medicine (MD), doctor of Chiropractic Medicine (DC), 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 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.

Plan Administrator

The Plan Administrator for this insurance is Point Comfort Underwriters, Inc., 306 Prospect Street, Indianapolis, Indiana, 46225. As the Plan Administrator, Point Comfort Underwriters, Inc. acts solely as the disclosed and authorized agent and representative for and on behalf of Underwriters, and does not have, and shall not be deemed, considered or alleged to have any direct, indirect, joint, several, separate, individual or independent liability, responsibility or obligation of any kind under this Master Policy, including the Master Policy Declaration and any exhibits, schedules, and/or endorsements attached hereto, or any Certificates, including Certificate Declarations, issued to Insured Persons, or to any other person or entity, including without limitation, any Physician, Hospital or Medical Provider or supplier.

Political Evacuation and Repatriation

Transportation of an Insured Person to an alternative country or location, and/or to the Insured Person’s Home Country, which becomes necessary due to Political Threat in the proximity of the Insured Person.

Political Threat

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.

Pre-existing Condition

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 Certificate Effective Date; (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 Certificate Effective Date; (3) Injury, Illness, sickness, disease, or other physical, medical, mental, or nervous condition, 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 Certificate Effective Date.

Preferred Medical Provider

Medical Providers designated by the Plan Administrator as preferred.

Preferred Provider Network; Network; PPO Network

Underwriters, via the Plan Administrator, endeavor to maintain contractual arrangements with one or more independent Preferred Provider Organizations (PPO) that have established and maintain Networks of US-based Physicians, Hospitals and other Medical Providers who are contracted separately and directly with the PPO and who may provide re-pricings, discounts or reduced charges for services and/or supplies provided to the Insured Person.

Pregnancy

The physical condition of being pregnant.

Premium Installment

The amount of premium due on each Installment Due Date, as indicated on the Certificate Declaration.

Primary Insurance

A group, individual or a government health plan (Medicaid, Medicare and V.A. health plans are considered Primary Insurance) that is the first pay or of claims for an Insured Person, in effect prior to the Certificate Effective Date and in effect at the time of any claim hereunder. Such plans must have coverage limits of at least $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.

Principal Residence

The location, indicated on the Insured Person’s Application, where the Insured Person ordinarily resides, not including locations in the Host Country. If more than one location meets this criteria, the Principal Residence is the location that meets this criteria and is listed on the Insured Person’s Application.

Professional Athletics

A sporting activity, including practice, preparation and actual sporting events, for any individual or organized team that is a member of a recognized professional sports organization, is a member of a playing league that is directly supported or sponsored by a professional team or professional sports organization, or has any athlete receiving for his or her participation any kind of payments or compensation, directly or indirectly, from a professional team or professional sports organization.

Professional Sports

A sporting activity, including practice, preparation and the actual event, 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.

R
Registered Nurse

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.

Related Third Person:

Any individual or natural person who is a Relative of the Insured Person, a traveling companion of the Insured Person or a Relative of such traveling companion and any other person, individual or family member with whom the Insured Person is residing or being hosted.

Relative

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.

S
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.

Spouse:

Legal or domestic partner who resides with the primary Insured Person and has resided with the Insured Person for at least six(6) consecutive months prior to the Certificate Effective Date, and who is at least 18 years of age and not yet 65 years of age.. The relationship must have met all the requirements of a valid marriage contract, domestic partnership or civil union in the state or location where the ceremony was performed.

Student Health Center

A medical facility operated by an Educational Institution for the care and treatment of its students, faculty and administration.

Substance Abuse

Alcohol, drug or chemical abuse, overuse or dependency.

Surgery; 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.

T
Termination Date

The date coverage for an Insured Person ends under the terms of the Master Policy, as indicated on the Certificate Declaration. test

Third Person:

Any individual, natural person or other legal entity or person, other than the Insured Person or any Related Third Party.

Travel Warning; Emergency Travel Advisory

Published statement or website document issued by the US Department of State, Bureau of Consular Affairs, Centers for Disease Control and Prevention, United Nations, World Health Organization or similar government or nongovernmental agency of the Insured Person’s Home Country, warning that travel to specified countries, regions or locations poses serious risks to safety and security or exposes the Insured Person to a greater likelihood of life-threatening risks, including, without limitation, US Department of State Travel advisory levels “3 – Reconsider travel” and “4 – Do not travel”.

U
United States; US

The United States of America including all states, districts, territories and possessions.

Urgent Care Center

A stand-alone facility, or a facility located inside a Hospital that staffs Physicians. Urgent Care Centers provide medical services for Injuries and Illnesses that are not life-threatening. Urgent Care Centers have onsite x-ray equipment and provide treatment for more severe urgent care services, such as broken bones, burns and other non-emergent conditions that Walk-in Clinics are unable to treat.

Usual, Reasonable and Customary

A typical and reasonable amount of expenses for similar services, medicines or supplies within the area in which the charge is incurred, so long as those expenses are reasonable. What is defined as Usual, Reasonable and Customary charges will be determined by Underwriters. In determining the typical and reasonable amount of expense, Underwriters may, in their reasonable discretion, consider one or more of the following factors, without limitation: the amount charged by the provider, the amount charged by similar providers or providers in the same or similar locality, the amount paid by other payers for the same or comparable services, medicines or supplies in the same or similar locality, whether the services or supplies were unbundled or should have been included in the allowance of another service, the amount charged by other providers for the same or comparable services, medicines or supplies in other parts of the country, the cost to the provider of providing the service, medicine or supply, 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 length of time required to perform the procedure or services as compared to national standards and/or benchmarks, the severity or nature of the Illness or Injury being treated, and such other factors as Underwriters, in the reasonable exercise of discretion, determine are appropriate.

V
Virtual Medicine Consultation

An electronic encounter with a Physician for the purpose of diagnosing or treating a covered Illness or Injury.

W
Walk-in Clinic

A medical facility that provides medical services for minor Injury or Illness. The clinics are often found in or near retail establishments or pharmacies. The staff providing medical services are usually nurse practitioners and Physician assistants.