You are here:

Definitions

Student Accident

COL-11

Hospital means an institution that meets all of the following: 1) 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 on a prearranged basis; and 6) it charges for its services.

Hospital also means a psychiatric hospital as defined by Medicare.  It must be eligible to receive payments under Medicare. A Hospital is mainly not a place for rest, a place for the aged, a place for the treatment of drug addicts or alcoholics, or a nursing home.

Injury means bodily injury caused by an Accident. The Injury must occur while the Policy is in force and while the Insured is covered under the Policy. The Injury must be sustained as stated on the face page of the Policy, except where specifically stated otherwise in the Policy.

Reasonable Expense means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.  Such services and supplies must be recommended and approved by a Physician.

 

COL-03

Hospital means a licensed or properly accredited general hospital which:  1) is open at all times; 2) is operated primarily and continuously for the treatment of and surgery for sick and injured persons as inpatients; 3) is under the supervision of a staff of one or more legally qualified Physicians available at all times; 4) continuously provides on the premises 24 hour nursing service by Registered Nurses; 5) provides organized facilities for diagnosis  on the premises; and 6) is not primarily a clinic, nursing, rest or convalescent home, or an institution specializing in or primarily treating Mental and Nervous Disorder.

Injury means bodily injury which is:  1) a sudden, unexpected and unforeseen, identifiable event producing objective symptoms of an accident; 2) unrelated to any pathological, functional, or structural disorder; 3) a source of loss; 4) treated by a Physician within 60 days after the date of accident; and 5) sustained while the Insured Person is covered under this policy.  All injuries sustained in one accident, including all related conditions and recurrent symptoms of these injuries will be considered one injury.  Injury does not include loss which results wholly or in part, directly or indirectly, from disease or other bodily infirmity.

Usual and Customary Charges means a reasonable charge which is:  1) usual and customary when compared with the charges made for similar services and supplies; and 2) made to persons having similar medical conditions in the locality where service is rendered.  No payment will be made under this policy for any expenses incurred which are in excess of Usual and Customary Charges.

 

Catastrophic Accident

Accident means a sudden, unexpected and unforeseen, identifiable event producing at the time objective symptoms of an Injury.  The Accident must occur while the Insured is covered under the Policy.

Brain Death means irreversible unconsciousness with: 1) Total loss of brain function; and 2) Complete absence of electrical activity of the brain, even though the heart is still beating. Brain Death must: 1) Occur within the period shown in the Schedule of Benefits; and 2) Be diagnosed by a Physician.

Coma means a profound state of unconsciousness from which the Insured is not likely to be aroused through powerful stimulation. This condition must be diagnosed and treated regularly by a Physician. Coma does not mean any state of unconsciousness intentionally induced during the course of treatment of a covered Accident, unless the state of unconsciousness results from administration of anesthesia in preparation for a Surgical Procedure of injuries sustained in that covered Accident.  The Insured’s Coma must: 1) Begin within the period shown in the Schedule of Benefits; 2) Continue for the period shown in the Schedule of Benefits; and 3) Be expected, as certified by a Physician, to continue for an indefinite period or end, leaving the Insured expecting, as certified by a Physician, to remain Totally Disabled for the remainder of their life.

Hospital means an institution that meets all of the following: 1) 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 on a prearranged basis; and 6) it charges for its services.

Hospital also means a psychiatric hospital as defined by Medicare.  It must be eligible to receive payments under Medicare. A Hospital is mainly not a place for rest, a place for the aged, a place for the treatment of drug addicts or alcoholics, or a nursing home.

Paralysis/Paralyzed means Quadriplegia, Paraplegia, Hemiplegia or Uniplegia that is expected to last for a continuous period of 6 months 30 days or more from the earlier of the date of the Accident causing Paralysis or the date of the diagnosis. “Quadriplegia” means the complete and irreversible Paralysis of both upper and lower limbs. “Paraplegia” means the complete and irreversible Paralysis of both lower limbs or both upper limbs. “Hemiplegia” means the complete and irreversible Paralysis of the upper and lower limbs of the same side of the body. “Uniplegia” means the complete and irreversible paralysis of one limb. “Limb” means entire arm or entire leg.

Partial Disability or Partially Disabled means the inability of the Insured who was engaged in an occupation before he became Totally Disabled, to perform all of the material duties of that occupation and to earn more than the maximum monthly earnings shown in the Schedule of Benefits.

Reasonable Expense means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.  Such services and supplies must be recommended and approved by a Physician.

Total Disability or Totally Disabled means the Insured has suffered permanent loss of one or more of: 1) speech; 2) hearing in both ears; 3) sight in both eyes; 4) use of both arms; 5) use of both legs; 6) use of one arm and one leg; or 7) motor or cognitive function resulting from brain stem or other neurological injury; and that permanent loss results in Insured's inability to: a) perform activities of daily living including eating, transferring, dressing, toileting, bathing, and continence without human supervision or assistance; or b) perform each and every duty of his occupation during the Initial Benefit Period; or c) perform each and every duty of any business or occupation for which he is reasonably fitted by education, training or experience, during the subsequent Benefit Period.