RL-ACC3-CERT2-23-IN 9 D12967 (11/25) Eligibility Waiting Period means the continuous period of time as shown in the SCHEDULE OF BENEFITS that you must be in Active Employment in an eligible class before you are eligible for coverage under the Policy. Emergency Room means a specified area within a Hospital, or a standalone facility licensed as an emergency room with the state, that is designated for emergency care. Employee means a person who is a citizen or legal resident of the United States in Active Employment with the Employer in the United States. The term includes a person whose coverage is being continued under the PORTABILITY provision, even if the person is no longer in Active Employment with the Employer. Employer means the Policyholder and includes any division, subsidiary or affiliated company named in the Policy. Fracture means a broken bone that can be seen by x-ray. Fracture Requiring Surgical Repair means the fracture is repaired through a surgical incision. Non-Surgical Repair means the fracture is reduced or repaired without a surgical incision. Hospital means an institution that is run for the care and treatment of sick or injured persons as inpatients and which, on its premises or in facilities available to the Hospital on a pre-arranged basis, fully meets each of the following requirements: It is operated in accordance with the laws pertaining to hospitals in the jurisdiction in which it is located. It is under the supervision of a medical staff and has one or more Doctors available at all times. It provides 24 hours a day service by registered graduate nurses (RNs). It is not an institution or any part of an institution used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. Insured Person means an Employee who is eligible for coverage under the Policy, becomes covered according to the terms of the Policy, and whose coverage remains in effect according to the terms of the Policy. Observation Unit means a specified area within a Hospital, apart from the Emergency Room, where a patient can be monitored by a Doctor, and that fully meets each of the following requirements: It is under the direct supervision of a Doctor or registered nurse. It is staffed by nurses assigned specifically to that unit. It provides care seven days per week, 24 hours per day. Outpatient Surgery means surgical services received at a Hospital or free-standing facility such as a surgical center licensed by the state to render outpatient surgery. The surgical service must be performed by a board certified surgical specialist with anesthesia rendered by a separate provider. Policy means the Written group insurance contract between the Policyholder and us, including the Certificates delivered to Insured Persons. It may include riders and endorsements. Policyholder means the Employer to whom the Policy is issued, as shown on the first page of this Certificate, and who sponsors the coverage for its Employees. Doctor means a person other than you or any family member, who is licensed to practice medicine in the state in which treatment is received and providing treatment or advice in accordance with the license. State law may require consideration of professional services of a practitioner other than a medical doctor. If so, then this definition includes persons recognized as qualified to treat the condition for which claim is made by the state in which treatment is received. Injury means a bodily Injury that is the direct result of a Covered Accident and not related to any other cause. Injuries must be independent of Sickness, disease, bodily infirmity and other causes.
Accident Insurance Plan for Noblesville Schools Employees Page 9 Page 11