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 - 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 - 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 - 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 - 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.