DEFINITIONS:

Any one Sickness or Injury means either Sickness or Injury from the same cause at various times or Sickness or Injury from various causes at the same time.

Calendar Year means the period beginning on the Certificate Effective Date and ending December 31 of that year. Thereafter it is the period from January 1 through December 31 of each following year.

Complications of pregnancy means any condition that requires medical treatment or Hospital confinement prior to or subsequent to the termination of the pregnancy whose diagnosis is distinct from, but is adversely affected by the pregnancy. Such conditions include, but are not limited to: (1) acute nephritis; (2) nephrosis; (3) cardiac decompensation; (4) missed abortion; and, (5) similar conditions of comparable severity. A complication of pregnancy will also include nonelective cesarean section or termination of pregnancy that occurs during a period of gestation when a viable birth is possible. "Complications of Pregnancy" will not include: (1) false labor; (2) occasional spotting; (3) prescribed bed rest; (4) morning Sickness; or, (5) similar conditions that are common to the care of a difficult pregnancy.

Covered Person means You and Your spouse, if any, that have been accepted for coverage.

Daily Hospital Benefit Amount means the amount we will pay each day when hospital confined. The Daily Hospital Benefit Amount is shown in the Certificate Schedule.

Doctor means any licensed practitioner of the healing arts operating within the scope of his or her license in treating any Injury or Sickness. It doesn't include a member of the Immediate Family.

Hospital means an institution which operates pursuant to law that has organized facilities for the care and treatment of sick and injured persons on a resident or inpatient basis, including facilities for diagnosis and surgery under the supervision of a staff of one (1) or more Doctors and which provides twenty-four (24)-hour nursing service by registered nurses on duty or call. Hospital does not mean convalescent, nursing, rest or extended care facilities or facilities operated exclusively for treatment of the aged, drug addict or alcoholic, even though such facilities are operated as a separate institution by a Hospital.

Hospital Confinement/Confined means confinement in a Hospital as a resident bed patient for a period of 23 consecutive hours or longer.

Hospital Elimination Period is the number of consecutive days when a loss is first incurred for which the Hospital Benefit is are payable under this Policy, but during which no benefits will be paid. For each day of Hospital Confinement to be applied towards the satisfaction of the Elimination Period, the loss must be otherwise covered by this Policy and eligible for benefits. When benefits do begin, they will not be retroactive to the beginning of the Elimination Period. The Elimination Period must be satisfied at the beginning of each period of Hospital Confinement.

Immediate Family means You or Your spouse, You or Your spouse's parents, grandparents, children, grandchildren, or siblings by blood or marriage.

Injury means an accidental bodily injury sustained by a You that is the direct cause of loss, independent of disease or bodily infirmity. The loss must begin while Your insurance under this Certificate is in force.

Insured means the person named as the Insured in the Certificate Schedule.

Intoxicated means that state that is determined by the laws and/or decisions of the jurisdiction in which loss because of being intoxicated occurs.

Maximum Outpatient Benefit Amount means the maximum amount we'll pay each calendar year for outpatient services. The Maximum Outpatient Benefit Amount is shown in the Certificate Schedule.

Medically Necessary means a service, supply, or hospital confinement that:

is prescribed by a Doctor;

is required for the treatment or management of a medical symptom or condition;

is the most efficient and economical service which can safely be provided; and

is commonly accepted as proper for the treatment or management of a condition by an established United States medical society.

All four of the above conditions must be met in order to establish Medical Necessity. The fact that a Doctor may prescribe, order, recommend or approve a service, supply or a confinement does not, of itself, make it Medically Necessary or a covered loss under this Certificate even though it is not specifically listed as an exception.

Mental Illness means a neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind classified in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders on the date care or medical treatment is rendered. It doesn't mean a demonstrable organic brain disease, such as Parkinson's disease, Alzheimer's disease or senile dementia.

Out-of-Pocket Costs means that portion of the expenses incurred that You are obligated to pay.

Sickness means an illness or a disease that results in loss covered by the Group Policy. The loss must begin while the Covered Person's insurance under this Certificate is in force.

Week means a period of 7 days beginning on a Sunday and ending on the following Saturday.