O-2002-2546 - Laserfiche WebLink

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Council on Medical Special Services, the National Institute of Health, Medicare, the Food and Drug Administration; and other accepted medical authorities and sources. INCURRED means the date on which an EligIble Expense was rendered to a Covered Person. INITIAL AGGREGATE ATTACHMENT POINT means the annual aggregate attachment point as calculated on the Effective Date based upon the number of Covered Units at that time multiplied by the corresponding attachment factors and multiplied by twelve. LATE ENROLLEE means any individual who makes a written application for coverage under the Plan more than a specified number of days (as indicated in the Plan) after first becoming eligible for coverage under the Plan. LOSS OR LOSSES mean amounts Paid, in accordance with the Policy Basis/Benefit Period shown on the Schedule, by You or the Administrator on Your behalf for benefits under the Plan, in settlement of claims for benefits under the Plan; or in satisfaction of judgments for benefits under the Plan. LOSS OR LOSSES, HOWEVER, DOES NOT INCLUDE: 1. any payment which does not strictly comply \-vith L~e provisions of the Plan; or 2. any payment for which there is any other insurance, reinsurance or plan established pursuant to federal, state or local law or any other indemnity against Loss which would, except for the existence of this Policy, indemnify the Insured; or 3. extra-contractual damages of any nature, compensatory damages, exemplary and punitive damages or liabilities of any kind whatsoever, including but not limited to those resulting from negligence, intentional wrongs, fraud, bad faith or strict liability on the part ofY ou, Your Administrator or Your agent or broker; or 4. salaries paid to Your employees as well as Your claim and administrative expenses; or 5. litigation costs and expenses. MAXIMUM AGGREGATE BENEFIT means the amount stated in the Schedule. MAXIMUM SPECIFIC BENEFIT means the amount stated in the Schedule. MINIMUM AGGREGATE ATTACHMENT POINT means an amount equal to 95% of the product of the Initial Enrollment of the first Covered Month of the Policy multiplied by the corresponding Aggregate Monthly Factor multiplied by twelve. MONTHLY AGGREGATE ATTACHMENT POINT means an amount equal to the product of the total Number of Covered Units per Covered Month of a Policy Year multiplied by the corresponding Aggregate Monthly Factor. NUMBER OF COVERED UNITS means the total Covered Units existing in anyone Covered Month and will be determined on a monthly basis in accordance with the definition of Covered Units; and the eligibility requirements of the Plan. SL-2001 6 (6/01)