Laserfiche WebLink
<br />SECTION 2-DEFINITIONS <br /> <br />ADMINISTRATOR means an organization which has been retained by You and approved by Us to <br />provide claim and administrative services for You. <br /> <br />AGGREGATE MONTHLY FACTOR means the amount applicable to each Covered Person as shown in <br />the Schedule. <br /> <br />ANNUAL AGGREGATE ATTACHMENT POINT which is determined at the end of the Policy Year <br />and is an amount equal to the product of the Aggregate Monthly Factor times the number of Covered Units <br />for each applicable month during the Policy Year. The Annual Aggregate Attachment Point is stated in the <br />Schedule and is descnbed in Section 3. This amount is that portion of the EligIble Expenses not covered by <br />this Policy and entirely retained by You for the total Number of Covered Units in each Policy Year. <br /> <br />APPLICATION means the application for excess loss insurance submitted by You to Us in connection <br />with the issuance of this Policy. <br /> <br />BENEFIT PERCENTAGE PAYABLE means the factor that determines the amOlmt of the Maximmn <br />Benefit payable to You as shown in the Schedule. Separate benefit percentages may apply to either the <br />Aggregate Excess Loss or to the Specific Excess Loss. <br /> <br />BENEFIT PERIOD means the period of time, as shown in the Schedule, during which a covered expense <br />must be Incurred, and/or Paid to be eligIble for reimbursement under this Policy. <br /> <br />COVERED MONTH is determined from the Effective Date. Each new Covered Month 'will begin on the <br />date which corresponds with the Effective Date. If there is no such date in any applicable month, then the <br />last date of that month will be used. <br /> <br />COVERED PERSON means an eligIble employee or eligIble dependent(s) . <br /> <br />COVERED UNIT includes an eligIble employee, eligIble employees and their dependents or such other <br />defined individuals as specifically agreed upon between You and Us. <br /> <br />DISCLOSURE STATEMENT means the disclosure statement submitted by You to Us in connection with <br />the issuance of this Policy. <br /> <br />ELIGIBLE EXPENSES means the reasonable and customary charges covered by the Plan and incurred by <br />a Covered Person while insured under the Plan for medically necessary treatment, services and/or supplies <br />prescnbed by an attending physician. <br /> <br />EFFECTIVE DATE means the date the coverage begins as stated in the Schedule. <br /> <br />EXPERIMENTAL or INVESTIGATIVE means care, procedures, treatments, or technology that are not <br />widely recognized and accepted as effective, safe and appropriate for the injury or illness by the medical <br />profession in the U.S., that are in research or Investigative stage, or conducted for research or similar <br />purposes; or for which the patient has been asked to give, or has signed, a release or other document, <br />indicating that the treatment is Experimental or Investigative or other similar tenn. <br /> <br />In determining any of the criteria stated above We will rely on recognized medical sources such as, but not <br />limited to the American Medical Association, the Council of Technology Assistance Program and the <br /> <br />SL-200l <br /> <br />5 <br /> <br />(6/01) <br />