incapable of self-sustaining employment by reason of mental or physical handicap.
A child, for purposes of this provision, includes an Employee’s: 1. natural child; 2. adopted child, from the earlier of the date the petition for adoption is filed or entry of the child in the adoptive home, or in the case of a child who is in the custody of the state, coverage shall begin at the date of entry of a final decree of adoption. It also means the legally adopted child of the Employee’s Spouse provided the child is living with, and is financially dependent upon the Employee; 3. stepchild who resides with the Employee and is financially dependent upon the Employee; 4. child for whom the Employee is the court-appointed legal guardian, as long as the child resides with the Employee and primarily depends on the Employee for financial support. Financial support means that the Employee is eligible to claim the dependent for purposes of Federal and State income tax returns. Emergency medical services and care given in a Hospital as an out or inpatient, for a sudden, unexpected onset of a medical condition of such nature that failure to render immediate care could reasonably result in deterioration to the point of placing a Covered Person’s life in jeopardy or cause serious impair ment to bodily functions.
Emergency Room Treatment
For eligibility purposes, an Employee of the Employer who is in one of the Covered Classes.
Employee
The Subscriber and any affiliates, subsidiaries or divisions shown in the Schedule of Affiliates and which are covered under this Policy on the date of issue or subsequently agreed to by Us.
Employer
Full-time means the number of hours set by the Subscriber as a regular work week for Employees in the Employee’s eligibility class .
Full-time
Refers to any individual, male or female.
He, His, Him, Himself
An institution that meets all of the following: 1.
Hospital
It is licensed as a Hospital pursuant to applicable law; 2. It is primarily and continuously engaged in providing medical care and treatment to sick and injured persons; 3. It is managed under the supervision of a staff of medical doctors; 4. It provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); 5. It has medical, diagnostic and treatment facilities, with major surgical facilities on its premises, or available to it on a prearranged basis; 6. It charges for its services.
The term Hospital does not include a clinic, facility, or unit of a Hospital for: 1. rehabilitation, convalescent, custodial, educational or nursing care; 2. the aged, drug addicts or alcoholics.
A confinement in a Hospital, ordered by a Physician, over a period of time when room and board and general nursing care are provided at a per diem charge made by the Hospital. The Hospital Stay must result directly and independently of all other causes from a Covered Accident/Loss. Separate Hospital Stays due to the same Covered Accident/Loss will be treated as one Hospital Stay unless separated by at least 90 days.
Hospital Stay
The period in the calendar year when an eligible Employee who was hired on or before the Policy Effective Date may enroll for the first time for Insurance Benefits under this Policy.
Initial Open Enrollment Period
14
Made with FlippingBook flipbook maker