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All students enrolled in the Student Accident/Sickness Insurance Program...
will be insured for the period for which premium has been paid, including interim vacations. Coverage begins on August 26, 2006 or the date of enrollment in the plan, whichever is later and continues until August 26, 2007. The postmark date of the application envelope will determine the effective date.You must enroll by September 15, 2006, as the insurance company may reject applications after that date. (Students transferring to Wilkes or initially enrolling for the second semester may enroll until February 28, 2007 for second semester coverage.) The following are the essential provisions of this plan, which...
will be incorporated in a Master Policy held by the College. Please note the following definitions for clarification of terms used in the policy. INJURY means bodily harm resulting, directly and independently of disease or bodily infirmity, from an accident. All injuries to the same person sustained in one accident, including all related conditions and recurring symptoms of injuries will be considered one injury. SICKNESS means illness or disease of a covered person. Sickness includes pregnancy and complications of pregnancy. All related conditions and recurring symptoms of sickness will be considered one sickness. USUAL, REASONABLE & CUSTOMARY means: (a) charges and fees for medical services or supplies that are lesser of: (1) the usual charge by the provider for the service or supply given; or (2) the average charged for the service or supply in the area where service or supply is received; and (b) treatment and medical service that is reasonable in relationship to the service or supply given and the severity of the condition. MEDICALLY NECESSARY means those services or supplies provided or prescribed by a hospital or doctor: (a) essential for the symptoms and diagnosis or treatment of the sickness or injury; (b) provided for the diagnosis, or the direct care and treatment of the sickness or injury; (c)in accordance with the standards of good medical practice; (d) not primarily for your convenience or that of your doctor; and (e) that are the most appropriate supply or level of service that can safely be provided. COVERED PERSON means you, the student, for which the proper premium has been made. Outline of benefits.
MENTAL AND NERVOUSPsychiatric care, consultations or medication paid as any other sickness. Excluded under Major Medical coverage. WOMEN'S HEALTH BENEFIT The policy will provide payment for the usual, reasonable and customary expense for a mammogram when recommended by a physician. Insureds age 40 and over will be covered for one mammogram every year whether or not recommended by a physician. Benefits will be paid the same as any other sickness for an annual gynecological examinations and pap smear. MATERNITY EXPENSE Maternity expenses are covered as any other sickness is covered under policy benefits. NEWBORN CHILDREN A newborn child or a child placed with you for adoptions shall be covered automatically for 31 days for the same benefits as are provided the Insured. Coverage applies to any injury sustained or sickness commencing during the 31-day period from the date of birth including medically diagnosed congenital defects, birth abnormalities, prematurity, routine nursery care, and immunizations. Schedule of Benefits.
Accidental Medical ExpensesFor each injury occurring while this policy is in force and requiring treatment within 30 days payment will be made for the usual Reasonable and Customary eligible expenses that are medically necessary actually incurred within 52 weeks from the date of injury, not to exceed $3,000 per accident. Covered expenses are usual, reasonable and customary charges for services of a physician or surgeon, hospital confinement, and other necessary medical care. Sickness Medical Expenses If sickness of an Insured requires medical services, payment will be made for the usual Reasonable and Customary eligible expenses that are medically necessary actually incurred within 52 weeks from the date of first treatment for sickness, not to exceed$3,000 per sickness. Covered expenses are usual, reasonable and customary charges for services of a physician or surgeon, hospital confinement, and other necessary medical care. Request for Premium Refunds for persons entering military service should be made to the Administrator. Refunds will not otherwise be made. Coverage for all other persons will continue until the end of the period for which premium has been paid. In the event of injury or sickness, students should...
Exclusions & Limitations
The policy does not cover any loss caused by or contribute to by, nor is any premium charge for:
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