Unless specifically defined elsewhere, wherever used in the Policy, the following terms have the meanings given below.

Accident (Accidental) means a sudden, unexpected and unforeseen, identifiable event producing at the time objective symptoms of an Injury. The Accident must occur while the Covered Person is insured under the Policy.

Coinsurance means the ratio by which the Covered Person and the Insurer share in the Payment of Reasonable Expenses for Medically Necessary treatment. The percentage the Insurer pays is stated in the Schedule of Benefits.

Copayment means the dollar amount of Reasonable Expenses for Medically Necessary services, treatments and supplies which the Insurer does not pay and which the Covered Person is responsible for paying. The dollar amount which the Covered Person must pay is stated in the Schedule of Benefits.

Covered Medical Expense means an expense actually incurred by or on behalf of a Covered Person for those services and supplies which are: 1) administered or ordered by a Physician; 2) Medically Necessary to the diagnosis and treatment of an Injury or Sickness; 3) are not excluded by any provision of the Policy; and incurred while the Covered Person’s insurance is in force under the Policy, except as stated in the Extension of Benefits provision. A covered Medical Expense is deemed to be incurred on the date such service or supply which gave rise to the expense or charge was rendered or obtained. Covered Medical Expenses are listed in the Schedule of Benefits.

Emergency Hospitalization and Emergency Medical care means hospitalization or medical care: 1) That is provided for an Injury or a Sickness caused by the sudden, unexpected onset of a medical condition with acute symptoms of sufficient severity and pain to require immediate medical care; and 2) In the absence of which one could reasonably expect that one or more of the following would occur: a) The Covered Person’s health would be placed in serious jeopardy; b) There would be serious impairment of the Covered Persons bodily functions; c) There would be serious dysfunction of any of the Covered Person’s bodily organs or parts.

Injury means bodily injury caused directly by an Accident. It must be independent of all other causes. To be covered, the Injury must first be treated while the Covered Person is insured under the Policy. A Sickness is not an Injury. A bacterial infection that occurs through an Accidental wound or from a medical or surgical treatment of a Sickness is an Injury.

Medically Necessary means medical and dental service, treatment or supplies which are: 1) Recommended by the attending Physician; 2) Consistent with generally accepted medical practice for the Injury or Sickness, as determined by the Insurer; 3) Generally considered by Physicians in the United States of America or as determined by the Administrator as prevailing in the geographic locality where and at the time the service or supply is rendered to be appropriate for the Injury or Sickness; and 4) Accepted as safe, effective and reliable by a medical specialty or board recognized by the American Board of Medical Specialties or as determined by the Administrator as prevailing in the geographic locality where and at the time the service or supply is rendered. A medical or dental treatment will not be deemed Medially Necessary if the Insurer determines that any service, supply or treatment used or provided in connection with the Injury or Sickness is Experimental or Investigational in nature. The fact that a Physician may prescribe order, recommend or approve a service or supply does not, of itself, make the service or supply Medically Necessary. If services do not meet the criteria above or are not consistent with professionally recognized standards of care with respect to quality, frequency or duration, such services will not be deemed Medically Necessary.

Preferred Provider means a Hospital, Physician, or other health care provider who has agreed to participate in the PPO. See Section

Preferred Provider Organization (PPO) means the networks(s) of Preferred Providers stated on the Insured Person’s identification card. See Section

Reasonable Expense means the normal charge of the provider, incurred by the Covered Person, in the absence of insurance, 1) for a medical service or supply, but not more than the prevailing charge in the area for a like service by a provider with similar training or experience, or 2) for a supply which is identical or substantially equivalent. The final determination of reasonable and customary charge rests solely with the Insurer.

Sickness means an illness, ailment, disease, or physical condition of a Covered Person starting while insured under the Policy.