Premium The amount of money paid to the Insurance Company to purchase the Insurance Plan.

Deductible The amount payable by the insured for any covered expense, before the Insurance pays any benefit. The deductible is paid to the medical provider.

Physician Means a legally qualified licensed practitioner of the healing arts who provides care within the scope of his/her license, other than a member of the person's immediate family.

Pre-Existing Condition Means a disease or condition for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months before the date of coverage.

Medical Emergency Emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms or sufficient severity including severe pain such that the absence of immediate medical attention could reasonably be expected to result in:
A) Placement of the Insured's health in serious jeopardy;
B) Serious impairment of bodily functions; or
C) Serious dysfunction of any body organ or part.

Claim Means a bill or receipt from a provider's offie listing medical expenses incurred by the insured person. Claims should be sent to the Insurance Company for consideration of payment or reimbursement.

Co-Insurance After the deductible has been met, the Co-Insurance indicates the percentage covered by the Insurance and the percentage the insured must pay. For example: If the Co-Insurance is 80/20, the Insurance will pay 80% and the insured is responsible for 20%.

Exclusion Represents services, supplies, or treatment not paid for by the Insurance Company.

Covered Medical Expense Means reasonable charges which are: 1) not in excess of Usual & Customary Charges; 2) not in excess of the maximum benefit amount payable per service as specified in the Schedule of Benefits; 3) made for services and supplies not excluded under the policy; 4) made for services and supplies which are a Medical Necessity; 5) made for services included in the schedule of Benefits; and 6) in excess of the amount stated as a Deductible, if any.

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 of the Policyholder.