Policy Definitions

YOU, YOUR, or YOURS means the covered student.

WE means BCS Insurance Company.

COVERED PERSON means any eligible person and, where applicable, eligible dependents who make application for, or for whom application is made and who is approved to participate in the benefit plans issued under this plan, provided the required insurance fee for such person’s and dependent’s insurance is paid when due.

EMERGENCY CARE means bona fide emergency services provided after the sudden onset of a medical condition resulting from an injury or sickness manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably expect to result in: 1) placing the patient’s health in serious jeopardy, 2) serious impairment to bodily function, or 3) serious dysfunction of a bodily organ or part.

INJURY means accidental bodily harm sustained by the covered person that resulted directly and independently of all other causes from an accident and occurs while coverage under this plan is in force.

PRE-EXISTING CONDITIONS means a condition for which a covered person received medical treatment, care, or advice within 6 months.

SICKNESS means illness or disease contracted and causing loss as to the covered person whose sickness is the basis of a claim. Any complications or any condition arising out of a sickness for which the covered person is being treated or has received treatment will be considered part of the original sickness.

USUAL, CUSTOMARY, and REASONABLE CHARGES (UCR): “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 service 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 large geographically significant area as determined by the Company.