Students and their eligible dependents wishing to purchase benefits must enroll during the open enrollment period at the beginning of the Fall Semester. Late enrollment is considered only if a change has occurred in your insured status regarding coverage that was in-force during the open enrollment period. Late enrollment must be completed within 30 days of the termination of other coverage. Contact Collegiate Insurance Resources for rates and forms. The Spring Semester open enrollment period is available only for new students first entering the University for the Spring Semester.
No benefit under this Policy in excess of $100.00 per Injury or Sickness is payable for any Expense incurred for Injury or Sickness which is paid or payable by: (1) other valid and collectible medical, health or Accident insurance; or (2) under an automobile insurance policy.
Covered Charge or Expense as used herein means those charges for any treatment, services or supplies that are: (a) for Network Providers, not in excess of the Preferred Allowance; (b) for Non-Network Providers, not in excess of the Usual, Customary and Reasonable Expenses; (c) not in excess of the charges that would have been made in the absence of this insurance; and (d) incurred while this Plan is in force as to the Covered Person.
Covered Person means any Eligible Person and, where applicable, Eligible Dependents who makes application for, or for whom application is made and who is approved to participate in the benefit plans issued under this Policy, provided the required premium for such Person's and Dependents insurance is paid when due.
I n j u r y m e a n s a c c i d e n t a l b o d i l y h a r m s u s t a i n e d b y t h e C o v e r e d P e r s o n t h a t r e s u l t e d d i r e c t l y a n d i n d e p e n d e n t l y o f a l l o t h e r c a u s e s f r o m a n A c c i d e n t a n d o c c u r s w h i l e c o v e r a g e u n d e r t h i s P o l i c y i s i n f o r c e .
Loss means medical expense covered by this Plan as a result of Injury or Sickness as defined in this Plan.
Medical Emergency means the unexpected onset of an Injury or Sickness which requires immediate or urgent medical attention which, if not provided, could result in a loss of life or serious permanent damage to a limb or organ or pain sufficient to warrant immediate care. A Medical Emergency does not include elective or routine care.
Medically Necessary or Medical Necessity means the services or supplies provided by a Hospital, Physician, or other provider that are required to identify or treat an Injury or Sickness and which, as determined by the Company, are: (1) consistent with the symptom or diagnosis and Treatment of the Injury or Sickness; (2) appropriate with regard to standards of good medical practice; (3) not solely for the convenience of the Covered Person; (4) the most appropriate supply or level of service which can be safely provided. When applied to the care of an Inpatient, it further means that the Covered Person's medical symptoms or condition requires that the services cannot be safely provided as an Outpatient.
Per Condition Aggregate Maximum means, for each Covered Person, the total amount of benefits payable for each Injury or Sickness under the Student Health Insurance Policy or Policies issued to the Policyholder immediately before this Plan.
Physician means a practitioner of the healing arts who is duly licensed in the state where he is practicing and who is treating within the scope and limitation of that license. The term Physician will not include the Covered Person or his spouse, children, brothers, sisters, or parents, or any person residing in his household.
Preferred Allowance means the amount a Network Provider will accept as payment in full for Covered Charges.
Sickness means sickness or disease which is the sole cause of the Loss. Sickness includes both normal pregnancy and complications of pregnancy. All sicknesses due to the same or a related cause are considered one Sickness.
Usual, Customary, and Reasonable Charges - "Usual" means those charges made by a provider for services and supplies rendered to all patients for the same or similar Injury or Sickness; "Customary" means those charges made by the majority of providers in the area for the same or similar services or supplies. "Reasonable" means those charges that do not exceed the majority of prevailing fees in the area for the same or similar services or supplies. Area means a county or larger geographically significant area as determined by the Company.
We, Us or Our means BCS Insurance Company.
You, Your or Yours means the Insured Student.