The following key definitions apply to the policy/certificate and riders as approved in most states. Definitions may vary by state. For a list of all definitions, refer to the actual policy/certificate.
Actively Employed
The primary insured person must be working at least the number of hours required for benefit eligibility as shown on the policyholder’s application and performing the substantial and material duties of their regular occupation. Normal vacation or personal days are considered actively employed. However, if vacation or personal days are used to cover disability, sickness or injury, those days are not considered actively employed.
Confined and Confinement
The assignment to a bed as a resident inpatient as prescribed by a physician in a hospital for a period of at least 20 continuous hours.
Covered Accident
An unforeseen event which (a) directly, independently and exclusively results in an injury, (b) occurs after this issue date, (c) occurs while the certificate is in force and (d) is not excluded by name or specific description in the certificate and (e) occurs while an insured person is off-the-job, if coverage is off-the-job only.
Covered Sickness (as applies to Hospital Sickness Rider and Outpatient Care Rider only)
An illness, infection or disease, which is not caused solely by an injury or is a result of an injury.
Dependent Grandchild(ren)
The primary insured person’s grandchild under 26 years of age, who is legally dependent on the primary insured person.
Dismemberment (as applies to Accidental Death and Dismemberment Rider only)
An Injury sustained in a Covered Accident, directly or independently of all other causes, resulting in the complete severance of a body extremity or the complete loss of sight, speech or hearing.
•Loss of a hand means that the hand is cut off through or above the wrist joint or the use of the hand is medically determined to be permanently lost.
•Loss of a foot means that the foot is cut off through or above the ankle joint or the use of the foot is medically determined to be permanently lost.
•Loss of a finger means that the finger is cut off at the joint proximate to the first interphalangeal joint where it is attached to the hand.
•Loss of a toe means that the toe is cut off at the joint proximate to the first interphalangeal joint where it is attached to the foot.
•Loss of sight of an eye means that at least 80% of vision is permanently lost after reasonable effort has been made to correct the Insured Person’s vision using the most advanced medically acceptable procedures and devices available.
•Loss of hearing means the total and irreversible loss of hearing in both ears. Loss of hearing does not include loss of hearing that can be corrected by the use of any hearing aid or device.
•Loss of speech means total and permanent loss of audible communication, if such loss cannot be corrected to any functional degree by any procedure, aid or device.
Elimination Period (as applies to Accident-Only Disability Income Rider only)
The number of consecutive days the employee or member must be totally disabled before being eligible to receive the monthly benefit. Assurity does not pay monthly benefits during the elimination period.
Emergency Room
A specified area within a hospital that is designated for the emergency care of accidental injuries. This area must (a) be staffed and equipped to handle trauma, (b) be supervised and provide treatment by physicians and (c) provide care seven days per week, 24 hours per day. An urgent care facility is not considered an emergency room.
Grace Period
The 31-day period after a due date in which premiums can still be paid and are considered to have been paid on the due date.
Hospital
A primary care medical facility operated pursuant to law. The hospital must have organized facilities to provide first-level treatment of sick and injured persons on an inpatient basis for which a charge is made. Organized facilities include emergency services, admissions services, clinical laboratory, diagnostic X-ray and an operating room. Treatment facilities for emergency, medical and surgical services must be provided within the hospital. The hospital must provide 24-hour nursing services by, or under the supervision of, a registered nurse (RN) and be supervised by a staff of one or more physicians. The hospital must also maintain on its premises the patient’s written history and medical records.
Not included is a hospital or institution or part of such hospital or institution which is licensed or used principally as (a) a hospice unit (including any beds designated as a hospice bed); (b) a swing bed; (c) a convalescent home; (d) a rest or nursing facility; (e) a skilled nursing facility; (f) a psychiatric unit; (g) a rehabilitation unit or facility or (h) a facility primarily affording custodial care, educational care or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, drug addicts or alcoholics.
Injury(ies)
Bodily harm that is caused solely by, or is the direct result of, a covered accident. All injuries sustained in any one covered accident and all complications and reoccurrences of complications are considered to be a single injury.
Insured Child(ren)
The primary insured person’s or their spouse’s natural children, stepchildren, foster children, adopted children or children placed as foster children or for adoption, who are younger than age 26.
Intensive Care Unit
A place which (a) is a specifically designated area of the hospital that provides the highest level of medical care and is restricted to patients who are critically ill or injured and who require intensive comprehensive observation and care, (b) is separate and apart from the surgical recovery room and from rooms, beds and wards customarily used for patient confinement, (c) is permanently equipped with special lifesaving equipment for the care of the critically ill or injured, (d) is under constant and continuous observation by a specially trained nursing staff assigned exclusively to the intensive care unit on a 24-hour basis and (e) has a physician assigned to the intensive care unit.
An intensive care unit is not any of the following step-down units: (a) a progressive care unit, (b) an intermediate care unit; (c) a private monitored room, (d) a sub-acute intensive care unit, (e) a modified/moderate care unit, (f) an observation unit or (g) any facility not meeting the definition of an intensive care unit.
Maximum Benefit Period (as applies to Accident-Only Disability Income Rider only)
The maximum period of time the monthly benefits are paid.
Observation Unit
A specified area within a hospital, apart from the emergency room, where a patient can be monitored by a physician following outpatient surgery or treatment in the emergency room and which (a) is under the direct supervision of a physician or registered nurse (RN), (b) is staffed by nurses assigned specifically to that unit and (c)provides care seven days per week, 24 hours per day.
Off-the-Job
An insured person is not working at any job for wage or profit, even if not with the policyholder.
Physician
A doctor of medicine or osteopathy who is duly licensed by the state medical board and practicing in the United States. Such physician cannot be a member of an insured person's immediate family or business associate and must be providing services within the scope of his or her license/specialty. Physician will also include nurse practitioners and physicians assistants. Practitioners other than those named above are not Physicians. For the purposes of the certificate, chiropractors and dentists are not considered physicians.
Physician’s Care (as applies to Accident-Only Disability Income Rider only)
The regular and personal care of a physician, which under prevailing medical standards, is appropriate for the condition causing the disability.
Pre-existing Condition (as applies to Hospital Sickness Rider only)
A Covered Sickness or physical condition for which, during the 12 months before the Issue Date, an Insured Person received medical consultation, diagnosis, advice or treatment from a Physician or had been prescribed medication.
Primary Insured Person
The employee listed on the certificate schedule.
Sub-Acute Intensive Care Unit
A place which (a) is a specifically designated area of the Hospital that provides a level of medical care below intensive care, but above a regular private or semi-private room or ward, (b) is separate and apart from the surgical recovery room and from rooms, beds and wards customarily used for patient Confinement, (c) is permanently equipped with special lifesaving equipment for the care of the critically ill or injured and (d) is under constant and continuous observation by a specially trained nursing staff.
A Sub-Acute Intensive Care Unit may be referred to by other names such as progressive care unit, modified/moderate care unit, intermediate care unit, or a step-down unit, but it is not a regular private or semi-private room or ward with or without monitoring equipment.
Telemedicine Services
The assessment, diagnosis and treatment of a patient provided in real-time by a Physician via video telecommunications technology.
Totally Disabled (as applies to Accident-Only Disability Income Rider only)
Due to an injury occurring while this rider is in force, the employee or member (a) is unable to perform the substantial and material duties of their own occupation, (b) is not working for wage or profit and (c) requires a physician’s care, unless the employee or member’s physician certifies the employee or member has reached the maximum point of recovery.
Urgent Care Facility
A freestanding facility, which is not part of a Hospital, or Emergency Room, which provides care on an urgent basis.